Frimley Guidelines

Local Anaesthesia for Uni/Total Knee Replacement

Option 1: ACB + surgical LIA

Regional anaesthetic technique Adductor canal block* (ACB) + surgical Local Infiltration of Anaesthetic (LIA)

WeightAdductor canal block*Volume of 0.125% Levobupivacaine + 1mg Adrenaline added to 200mls BagDose in LIA mgTotal Dose
mg
>70kgs15ml 0.25% bupivacaine (37.5mg)90mls112.5150
55-69kg70mls87.5125
50-54kg50mls62.5100
<50kgTBC with anaesthetist2mg/kg

Option 2: ACB + genicular blocks + surgical LIA

Regional anaesthetic techniques (ACB + genicular blocks) + surgical LIA

WeightAdductor canal block*Genicular nerve blocksTotal Anaesthetic doseSurgical doseTotal dose
>70kg15ml 0.25% bupivacaine15ml 0.25% bupivacaine75mg (30ml of 0.25% bupivacaine)75mg
(60ml of 0.125% levo/bupivacaine)		150mg
55-69kg15ml 0.25% bupivacaine15ml 0.25% bupivacaine75mg (30 ml 0.25% bupivacaine)50mg
(40ml of 0.125% levo/bupivacaine)		125mg
50-54kg15ml 0.167% bupivacaine15ml 0.167% bupivacaine50mg (30ml 0.167%.
i.e. 20ml of 0.25% bupivacaine diluted to 30mls with 0.9% NaCl)		50mg
(40mls of 0.125% levo/bupivacaine)		100mg
<50kgTBC with anaesthetist2mg/kg

For surgical LIA: mix 1mg adrenaline in a 200ml bag of 0.125% levobupivacaine# and draw off the appropriate volume for infiltration under sterile conditions

Tip: Focus surgical infiltration around posterior capsule and skin incision

* Adductor Canal Block (ACB) or distal femoral triangle block
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