Background and aims Local infiltration analgesia is widely used in patients undergoing total knee arthroplasty, which frequently contains epinephrine for prolonged analgesic effect and reducing systemic absorption of local anesthetic. We investigated the hemodynamic effect of epinephrine-containing local infiltration analgesia after tourniquet deflation during total knee arthroplasty.

Methods We reviewed the electronic medical records of patients who had total knee arthroplasty between January 2017 and February 2018 in a tertiary care university hospital. Total knee arthroplasty was performed using a conventional technique with a pneumatic tourniquet. Local infiltration analgesia consisted of ropivacaine, morphine sulfate, ketorolac, and methylprednisolone. the participants were grouped according to whether epinephrine was included in local infiltration analgesia, and the incidence of hypertensive response (systolic blood pressure > 160 mmHg or mean blood pressure > 110 mmHg) after tourniquet deflation was compared between the two groups.

Results A total of 452 patients were analyzed, with 264 patients receiving local infiltration analgesia without epinephrine and 188 patients receiving epinephrine-containing local infiltration analgesia. Hypertensive response after tourniquet deflation occurred more frequently in patients receiving epinephrine-containing local infiltration analgesia (42/188 [22.3%]), compared with those receiving local infiltration analgesia without epinephrine (14/264 [5.3%], P<0.001). However, the incidence of hypotension after tourniquet deflation was comparable between the two groups (P=0.976).

Conclusions Epinephrine-containing local infiltration analgesia can result in hypertensive response after tourniquet deflation during total knee arthroplasty, which may be threatening in patients with several cardiovascular comorbidities.