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Knee Arthrocentesis Medication

  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
 
Updated: May 16, 2016
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Local Anesthetics, Amides

Class Summary

Local anesthetics block the initiation and conduction of nerve impulses.

Lidocaine (Xylocaine)

 

Lidocaine is an amide local anesthetic used in 1-2% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; the 2% preparation contains 20 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels.

To improve local anesthetic injection, cool the skin with ethyl chloride before injection. Use a 25- or 27-gauge needle to inject 2-5 mL of local anesthetic (eg, lidocaine 1%) into the subcutaneous tissue. Make sure the solution is at body temperature. Infiltrate very slowly to minimize the pain. The time from administration to onset of action is 2-5 minutes, and the effect lasts for 1.5-2 hours.

Buffering the solution helps reduce the pain of local lidocaine injection. Sodium bicarbonate can be added to injectable lidocaine vials (1 part bicarbonate to 9 parts lidocaine) to produce buffered lidocaine. The shelf-life of buffered lidocaine is approximately 1 week at room temperature. All vials should be marked "buffered," labeled with the time and date, and signed by the person who created the buffered mixture.

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003 Jul 1. 68(1):83-90. [Medline]. [Full Text].

  2. Zuber TJ. Knee joint aspiration and injection. Am Fam Physician. 2002 Oct 15. 66(8):1497-500, 1503-4, 1507. [Medline]. [Full Text].

  3. Sibbitt WL Jr, Kettwich LG, Band PA, Chavez-Chiang NR, DeLea SL, Haseler LJ, et al. Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?. Scand J Rheumatol. 2012 Feb. 41(1):66-72. [Medline].

  4. Zhang Q, Zhang T, Lv H, Xie L, Wu W, Wu J, et al. Comparison of two positions of knee arthrocentesis: how to obtain complete drainage. Am J Phys Med Rehabil. 2012 Jul. 91(7):611-5. [Medline].

  5. Self WH, Wang EE, Vozenilek JA, del Castillo J, Pettineo C, Benedict L. Dynamic emergency medicine. Arthrocentesis. Acad Emerg Med. 2008 Mar. 15(3):298. [Medline].

  6. Thomsen TW, Shen S, Shaffer RW, Setnik GS. Videos in clinical medicine. Arthrocentesis of the knee. N Engl J Med. 2006 May 11. 354(19):e19. [Medline].

  7. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis?. JAMA. 2007 Apr 4. 297(13):1478-88. [Medline].

  8. Li SF, Cassidy C, Chang C, Gharib S, Torres J. Diagnostic utility of laboratory tests in septic arthritis. Emerg Med J. 2007 Feb. 24(2):75-7. [Medline].

  9. McGillicuddy DC, Shah KH, Friedberg RP, Nathanson LA, Edlow JA. How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?. Am J Emerg Med. 2007 Sep. 25(7):749-52. [Medline].

  10. Reichman and Simon. Emergency Medicine Procedures. 1st. New York: McGraw Hill; 2004.

 
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Anterior view of right knee.
Anatomic landmarks for knee arthrocentesis.
Infiltration of local anesthetic via medial parapatellar approach (left knee).
Left-knee aspiration via medial parapatellar approach.
Application of bandage after left-knee aspiration.
Table 1. Characteristics of Synovial Fluid on Analysis
  Appearance WBCs, cells/µL PMN cells Glucose concentration, mg/dL Protein concentration, g/dL
Normal Clear <150 <0.25 Serum glucose 1.3-1.8
Noninflammatory Clear <3000 <0.25 Serum glucose 2-3.5
Inflammatory Cloudy >3000 <0.75 <25 >4
Purulent Cloudy >50,000 >0.9 <25 >4
Hemorrhagic Bloody >2000 ~0.3 Serum glucose
PMN = polymorphonuclear; WBC = white blood cell.
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