Local Infiltration Analgesia - a technique to improve outcome after hip, knee or lumbar spine surgery

118 pps, soft cover. Includes tables, graphs and full colour photos. Available also in Kindle edition.

Author: Dr Dennis R Kerr from Joint Orthopaedic Centre, Bondi Junction, Australia. Published by Informa Healthcare.

Described as a 'technique to improve outcomes' after hip, knee or lumbar surgery, this small but detailed book is aimed rather specifically at orthopaedic surgeons in private practice and challenges accepted norms for post-operative care of orthopaedic patients.

The very experienced anaesthetist author, Dr Dennis Kerr, encourages surgeons to be personally proactive in the adequate blocking of postoperative pain using a multimodal approach based on earlier work by Dr John Repicci but further developed for knee surgery by Dr Kerr together with orthopaedic surgeons Dr Lawrence Kohan and Dr Tord Rostlund.

He highlights the issue that most of these orthopaedic patients are not ill when they present for surgery, but the combination of inhalational anesthesia, intra- and post-operative drugs, regional nerve or epidural blocks, drips, urinary catheters, repeated blood tests and confinement to bed renders them physiologically unstable and hospital-dependent, vulnerable to deep vein thrombosis, pulmonary embolism and hospital-acquired infections. Most of this instability he posits can be avoided by his analgesic regime, which allows early ambulation and discharge and avoidance (or early termination) of invasive interventions.

Dr Kerr draws attention to the inadequacies of the 'compartmentalisation of care' where surgeon, anaesthetist and pain management doctor are each occupied only with 'their' portion of the patient's surgery and post-surgery recovery. He states that 'pain management should be considered as a process and not an event', and that this surgeon-initiated regime of intra-operative wound infiltration allows a reduction of pain and other intervention through the whole postoperative period and improves the total outcome. 

The book goes into details of relevant anatomy and physiology, and then the exact procedure of preparing and infiltrating the Ropivacaine-Ketorolac-Adrenaline mixture. Safety issues and Outcomes are discussed in separate chapters. The infiltration technique is further discussed in separate chapters in relation to the consequent reduction in venous thrombo-embolism and infection, and a chapter is dedicated to the technique in relation to lumbar spine surgery. Finally there are two chapters amplifying the whole approach to pain management post-operatively and how to facilitate the outcome of this infiltration technique.