Local Anesthetic Systemic Toxicity Following High-Volume Ropivacaine, Epinephrine, Clonidine, and Ketorolac (RECK) Infiltration During Total Knee Arthroplasty: A Case Report.
- 1Anesthesia, Duke University, Durham, USA.
Abstract
Local infiltration analgesia is widely used for post-operative pain control following joint arthroplasty and is generally considered to carry a low risk of local anesthetic systemic toxicity. We report a case of local anesthetic systemic toxicity in a 72-year-old woman following primary total knee arthroplasty performed under spinal anesthesia with adjunctive adductor canal block and high-volume periarticular infiltration with ropivacaine, epinephrine, clonidine, and ketorolac (RECK) solution. The cumulative perioperative ropivacaine dose was 286 mg (3.9 mg/kg). Soon after arrival in the post-anesthesia care unit, the patient developed acute confusion and focal myoclonic activity in the right arm without cardiovascular instability. Lipid emulsion was administered with rapid and complete neurological recovery. This case highlights the importance of considering cumulative dosing across regional and surgical infiltration techniques, the influence of patient-specific factors on susceptibility to toxicity, and the need for vigilance for delayed manifestations of local anesthetic systemic toxicity following high-volume infiltration.
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BibTeX
@article{mendelson2026local,
title = {{Local Anesthetic Systemic Toxicity Following High-Volume Ropivacaine, Epinephrine, Clonidine, and Ketorolac (RECK) Infiltration During Total Knee Arthroplasty: A Case Report.}},
author = {Brian Mendelson and Jose Perdomo Trejo and Soliana Bekele},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116865},
url = {https://europepmc.org/article/MED/42927398},
note = {CC BY},
}
RIS
TY - JOUR
TI - Local Anesthetic Systemic Toxicity Following High-Volume Ropivacaine, Epinephrine, Clonidine, and Ketorolac (RECK) Infiltration During Total Knee Arthroplasty: A Case Report.
AU - Brian Mendelson
AU - Jose Perdomo Trejo
AU - Soliana Bekele
PY - 2026
DA - 2026/09/24
JO - Cureus
DO - 10.7759/cureus.116865
UR - https://europepmc.org/article/MED/42927398
AB - Local infiltration analgesia is widely used for post-operative pain control following joint arthroplasty and is generally considered to carry a low risk of local anesthetic systemic toxicity. We report a case of local anesthetic systemic toxicity in a 72-year-old woman following primary total knee arthroplasty performed under spinal anesthesia with adjunctive adductor canal block and high-volume periarticular infiltration with ropivacaine, epinephrine, clonidine, and ketorolac (RECK) solution. The cumulative perioperative ropivacaine dose was 286 mg (3.9 mg/kg). Soon after arrival in the post-anesthesia care unit, the patient developed acute confusion and focal myoclonic activity in the right arm without cardiovascular instability. Lipid emulsion was administered with rapid and complete neurological recovery. This case highlights the importance of considering cumulative dosing across regional and surgical infiltration techniques, the influence of patient-specific factors on susceptibility to toxicity, and the need for vigilance for delayed manifestations of local anesthetic systemic toxicity following high-volume infiltration.
SN - 2168-8184
ER -