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In vitro elution of local anaesthetics from PMMA bone cement
Estudio in vitro de elución de anestésicos locales en cemento óseo de PMMA
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"apellidos" => "Balaguer-Castro" "email" => array:1 [ 0 => "mbalaguer@clinic.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio <span class="elsevierStyleItalic">in vitro</span> de elución de anestésicos locales en cemento óseo de PMMA" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1197 "Ancho" => 2175 "Tamanyo" => 153105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Elution procedure outline.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Total knee arthroplasty (TKA) is one of the most commonly used procedures in patients with chronic refractory knee pain in whom conservative treatment has failed.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Postoperative pain after TKA implantation is usually moderate to severe and can be difficult to control, especially during the first 3 postoperative days.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a> Achieving optimal pain control improves function, facilitates rehabilitation and attenuates the progression from acute to chronic pain.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a> Currently, there is no gold standard for postoperative pain management after TKA,<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">4–7</span></a> since analgesics can be administered through different routes and none of these is ideal, as adverse reactions are frequent and complications can arise.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> The ideal analgesic delivery system should be able to provide therapeutic, non-toxic doses at the surgical site, especially during the first 72<span class="elsevierStyleHsp" style=""></span>h. In the management of pain following RKA implantation, polymethylmethacrylate (PMMA) bone cement could be used as a local drug delivery system to achieve an analgesic effect.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since 1970, studies have been conducted analysing the ability of PMMA bone cement as a local drug release system, especially for antibiotics.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a> The elution pattern of these drugs shows a high initial drug release followed by a decrease in drug release over the following days.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The elution of drugs from the cement will be conditioned by some factors, such as the water uptake of the cement, the porosity of the cement matrix, the composition of the cement, the cement surface, the particle size of the drug and the drug content.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11–13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Following these initial studies and taking into account that local anaesthetics (LAs) are drugs with an excellent safety and effectiveness profile, some authors have tested the elution capacity of LAs from PMMA bone cement,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8,14</span></a> obtaining variable elution figures depending on the drug and the cement used.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study is to analyse the elution profile of lidocaine hydrochloride and bupivacaine hydrochloride from PMMA bone cement with gentamicin.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study was conducted with the approval of the clinical research ethics committee (HCB 2020/0097) and following the regulations of the international standards ISO 5833:2022 Implants for surgery-Acrylic resin cements and the Standard Specification for Acrylic Bone Cement ASTM F451-16.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two study groups were defined: cement group with lidocaine hydrochloride (GL) and cement group with bupivacaine hydrochloride (GB).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The LA dose was defined taking into account the elution percentages reported in previous studies<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8,14</span></a> and aiming for a total eluted dose of 020<span class="elsevierStyleHsp" style=""></span>g lidocaine and .14<span class="elsevierStyleHsp" style=""></span>g bupivacaine. These doses correspond to usual doses used in anaesthetic blocks and to the usual estimate of 3<span class="elsevierStyleHsp" style=""></span>mg/kg and 2<span class="elsevierStyleHsp" style=""></span>mg/kg for a patient with an average weight of 70<span class="elsevierStyleHsp" style=""></span>kg for lidocaine<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> and bupivacaine,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> respectively. The calculated doses were 2.48<span class="elsevierStyleHsp" style=""></span>g in the lidocaine (GL) group and 3.58<span class="elsevierStyleHsp" style=""></span>g in the bupivacaine (GB) group. Lidocaine hydrochloride and bupivacaine hydrochloride (Fagron®, Terrassa) were used.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Palacos® R<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>G (Heraeus Medical GMBH, Germany), a fast-setting, high-viscosity PMMA composite bone cement containing gentamicin, was used.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Moulds (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) for the creation of the cylindrical specimens of 6<span class="elsevierStyleHsp" style=""></span>mm diameter<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mm height were fabricated by machining in Teflon. As the standard does not specify the dimensions of the specimens for elution analyses, the references for mechanical studies on this type of cements, specified in ISO 5833:2002, were used.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">For the preparation of the GL and GB specimens, the powdered LAs (lidocaine hydrochloride or bupivacaine hydrochloride) were mixed with the powdered component of the cement using the geometric dilution method. The liquid component of the cement was added to the mixture according to the manufacturer's recommendations. The mixture was allowed to stand for 30<span class="elsevierStyleHsp" style=""></span>s and was introduced into the moulds, removing the excess. It was left to dry for 30<span class="elsevierStyleHsp" style=""></span>min and then the specimens were removed.</p><p id="par0065" class="elsevierStylePara elsevierViewall">A sample size of 3 specimens per study group and time cut-off was set arbitrarily, as there are no regulations governing the study of elution at present.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The elution process follows the law of diffusion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), is carried out from the surface and is directly related to the water absorption capacity of the cement. In order to obtain specimens with similar contact surfaces, the 3 most homogeneous specimens (A, B, C) of each group in terms of size and weight were selected.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Specimens were placed in cryovials, immersed in 4<span class="elsevierStyleHsp" style=""></span>ml of saline (PBS) at room temperature and placed on an oscillating shaker. At the set cut-off points (1<span class="elsevierStyleHsp" style=""></span>h, 3<span class="elsevierStyleHsp" style=""></span>h, 6<span class="elsevierStyleHsp" style=""></span>h, 24<span class="elsevierStyleHsp" style=""></span>h, 48<span class="elsevierStyleHsp" style=""></span>h, 72<span class="elsevierStyleHsp" style=""></span>h, 168<span class="elsevierStyleHsp" style=""></span>h and 336<span class="elsevierStyleHsp" style=""></span>h) the specimens were removed from the solution and the cryovials were stored at −80<span class="elsevierStyleHsp" style=""></span>°C. In the obtained samples, the concentration of AL in the liquid was analysed by liquid chromatography (HPLC).</p><p id="par0080" class="elsevierStylePara elsevierViewall">To give internal validity to the determination method, the analysis of the AL concentration was repeated in triplicate, in each study group and time cut-off.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> show the concentration of lidocaine and bupivacaine in μg/ml in each of the samples analysed, and the mean and standard deviation (SD) of concentration at each time point. At the same time, the percentage of lidocaine and bupivacaine released with respect to the total LA present in the cement mixture is shown.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">For the calculation of the percentage of lidocaine released with respect to the total lidocaine present in the specimen, the following estimation was made: in the GL group, 2.48<span class="elsevierStyleHsp" style=""></span>g of lidocaine was added to 40.8<span class="elsevierStyleHsp" style=""></span>g of powdered cement, representing a total powder weight of 43.28<span class="elsevierStyleHsp" style=""></span>g. In group GB, 3.58<span class="elsevierStyleHsp" style=""></span>g of bupivacaine was added to 40.8<span class="elsevierStyleHsp" style=""></span>g of powder cement representing a total powder weight of 44.38<span class="elsevierStyleHsp" style=""></span>g. If the average weight of the specimens was .43<span class="elsevierStyleHsp" style=""></span>g and they were immersed in 4<span class="elsevierStyleHsp" style=""></span>ml of PBS, the expected maximum concentration, if 100% lidocaine eluted, would be 6160<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>μg/ml in the GL group and 8672<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>μg/ml in the GB group. These calculations have been made using the formula shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72<span class="elsevierStyleHsp" style=""></span>h and 18.73% at 336<span class="elsevierStyleHsp" style=""></span>h (14 days).</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows the graph of the average eluted concentration of lidocaine in the different time slices.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The percentage of bupivacaine eluted from PMMA bone cement in this study was 2.71% of the total bupivacaine content per specimen at 72<span class="elsevierStyleHsp" style=""></span>h and 2.70% at 336<span class="elsevierStyleHsp" style=""></span>h (14 days). <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> shows the graph of the average eluted concentration of bupivacaine in the different time slices.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">To carry out this study we chose the bone cement Palacos® R<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>G, a high viscosity cement containing gentamicin sulphate like the cements we usually use in our environment. Palacos® (Heraeus) is one of the most widely used brands on the market for arthroplasty fixation.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">We selected two LAs to evaluate their elution in bone cement with antibiotics. On the one hand, lidocaine, as an anaesthetic with a short half-life and, on the other, bupivacaine, as an anaesthetic with a longer half-life. Both have good thermal resistance, an essential condition, since in vitro PMMA can reach temperature peaks during curing of up to 80–90<span class="elsevierStyleHsp" style=""></span>°C.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">11,18</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Two previous studies have been performed analysing the elution of different LAs added to PMMA bone cements. In the study by Bond et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> they added lidocaine, prilocaine, bupivacaine and tetracaine to 5 PMMA bone cements without antibiotic. A percentage elution of the different LAs between .05 and 1.10% at 72<span class="elsevierStyleHsp" style=""></span>h was reported. In the study by Balaguer et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> they added lidocaine and bupivacaine to a medium viscosity PMMA bone cement containing gentamicin. They reported a lidocaine elution percentage of 25.49% at 72<span class="elsevierStyleHsp" style=""></span>h and 38.48% at 14 days. At the same time, they reported a bupivacaine elution rate of 3.18% at 72<span class="elsevierStyleHsp" style=""></span>h and 4.53% at 14 days.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our study, lidocaine elution percentages were 9.74% at 72<span class="elsevierStyleHsp" style=""></span>h and 18.73% at 14 days (336<span class="elsevierStyleHsp" style=""></span>h). In the case of bupivacaine, the elution percentage was 2.71% at 72<span class="elsevierStyleHsp" style=""></span>h and 2.70% at 14 days (336<span class="elsevierStyleHsp" style=""></span>h).</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the two study groups GL and GB and in the two time slices, elution was lower than that reported by Balaguer et al. These differences in results could be justified by the fact that they did not use the same bone cement as we did and used a different LA dose. Despite having used higher doses of LA in our study, the percentage of elution is lower. This result could be justified by the fact that the elution of drugs from the bone cement takes place from the surface<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> and may be limited despite the increase in drug dose.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our results and those of Balaguer et al. show a higher elution than that reported by Bond et al. In Bond's study, bone cement without antibiotic, physiological saline instead of PBS and other geometrical characteristics of the samples were used.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the interpretation of our results and from a theoretical point of view, we should take into account two main factors: the maximum total amount of drug eluted and the dose of drug needed to block the A and C fibres that are responsible for pain conduction.</p><p id="par0145" class="elsevierStylePara elsevierViewall">If we were to use the entire cement (40.8<span class="elsevierStyleHsp" style=""></span>g), the maximum eluted dose of lidocaine would be reached after 14 days (336<span class="elsevierStyleHsp" style=""></span>h) with an elution percentage of 17.66%, corresponding to .438<span class="elsevierStyleHsp" style=""></span>g of AL. As for bupivacaine, the maximum dose would be reached at 7 days (168<span class="elsevierStyleHsp" style=""></span>h) with an elution percentage of 2.98%, corresponding to .106<span class="elsevierStyleHsp" style=""></span>g bupivacaine.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In the case of lidocaine, the maximum dose would exceed the toxic dose of 3.5<span class="elsevierStyleHsp" style=""></span>mg/kg in a 70<span class="elsevierStyleHsp" style=""></span>kg adult. In contrast, bupivacaine would not exceed the toxic dose of 2<span class="elsevierStyleHsp" style=""></span>mg/kg in a 70<span class="elsevierStyleHsp" style=""></span>kg adult.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> In this sense, we have to take into account that this interpretation disregards the phenomena of absorption, metabolisation and elimination of LAs that would be present in in vivo studies.</p><p id="par0155" class="elsevierStylePara elsevierViewall">If we interpret the elution results obtained at 72<span class="elsevierStyleHsp" style=""></span>h, we observe that the amount of lidocaine eluted corresponds to .22<span class="elsevierStyleHsp" style=""></span>g and that of bupivacaine to .09<span class="elsevierStyleHsp" style=""></span>g. These figures are close to the usual doses used in anaesthetic blocks of .20<span class="elsevierStyleHsp" style=""></span>g lidocaine and .14<span class="elsevierStyleHsp" style=""></span>g bupivacaine.</p><p id="par0160" class="elsevierStylePara elsevierViewall">With regard to the dose of LA required to achieve a therapeutic effect, we can use as a reference the classic electrophysiological studies<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">20–24</span></a> that determine the amount of LA in vitro that blocks nerve conduction of the A and C fibres responsible for the transmission of painful stimuli. These in vitro studies establish doses of .084–08<span class="elsevierStyleHsp" style=""></span>mM<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">25,26</span></a> for lidocaine and .048–0.200<span class="elsevierStyleHsp" style=""></span>mM<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">24,27</span></a> for bupivacaine.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The elution results obtained in our study at 72<span class="elsevierStyleHsp" style=""></span>h in the two study groups GL and GB exceed the minimum doses established for the two drugs.</p><p id="par0170" class="elsevierStylePara elsevierViewall">LAs can be administered in the context of knee arthroplasty by different techniques such as anaesthetic blockade, LAI (local anaesthetic infiltration), joint puncture or experimentally using bone cement as a drug carrier. The latter technique would avoid the adverse effects associated with the techniques listed above and could allow drug elution to be maintained for a longer period of time.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Subsequent to the elution analysis of these drugs, we should analyse how their addition to bone cement acts on workability and mechanical properties.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Previous studies have reported that the manual addition of 2<span class="elsevierStyleHsp" style=""></span>g of antibiotic powder to the powdered component of bone cement reduces the flexural strength by 20% and the impact strength by 23%.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a> The regulations of the international standards ISO 5833:2022 Implants for surgery-Acrylic resin cements and the Standard Specification for Acrylic Bone Cement ASTM F451-16 set minimum values for flexural strength of 50<span class="elsevierStyleHsp" style=""></span>MPa, compressive strength of 70<span class="elsevierStyleHsp" style=""></span>MPa and Young's modulus of 1800<span class="elsevierStyleHsp" style=""></span>MPa.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Regarding LAs, Giordano et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> reported that the addition of LAs to bone cement increases its impact strength. Lotfi et al.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> reported that bone cements that set in a liquid environment containing ropivacaine decrease their compressive strength with respect to those set in air.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The main limitation of this study is the fact that it is not possible to generalise the results to in vivo conditions due to the in vitro study and the small sample size analysed.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Our future lines of research include carrying out workability and mechanical tests to confirm that the addition of these drugs does not alter these properties of PMMA bone cement. In parallel, the possibility of using other anaesthetics such as levobupivacaine or ropivacaine, with a medium half-life and a high safety profile.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Level of evidence</span><p id="par0200" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">v</span>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">This research was partially funded by the <span class="elsevierStyleGrantSponsor" id="gs1">Spanish Society of Orthopaedic Surgery and Traumatology (SECOT)</span> with the “Aid for Research Projects in Orthopaedics and Trauma Surgery” of the SECOT Foundation and by the Josep Trueta Grant of the Catalan Society of Orthopaedic Surgery and Traumatology (SCCOT).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest with regard to obtaining the bone cements used from the Palacos® R<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>G brand or the local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from the Fagron® brand.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2130278" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1809139" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2130279" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1809140" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Level of evidence" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-01-04" "fechaAceptado" => "2023-03-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1809139" "palabras" => array:6 [ 0 => "Lidocaine" 1 => "Bupivacaine" 2 => "Analgesia" 3 => "Cement" 4 => "Arthroplasty" 5 => "Elution" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1809140" "palabras" => array:6 [ 0 => "Lidocaína" 1 => "Bupivacaína" 2 => "Analgesia" 3 => "Cemento" 4 => "Artroplastia" 5 => "Elución" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Currently, we do not have a <span class="elsevierStyleItalic">gold standard</span> for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72<span class="elsevierStyleHsp" style=""></span>h postoperatively.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterise the elution profile of two local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Palacos® R<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Subsequently, the concentration of local anaesthetic in the liquid was analysed by liquid chromatography.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72<span class="elsevierStyleHsp" style=""></span>h and 18.73% at 336<span class="elsevierStyleHsp" style=""></span>h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72<span class="elsevierStyleHsp" style=""></span>h and 2.70% at 336<span class="elsevierStyleHsp" style=""></span>h (14 days).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Local anaesthetics elute in vitro from PMMA bone cement, reaching doses at 72<span class="elsevierStyleHsp" style=""></span>h close to the doses used in anaesthetic blocks.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Actualmente no disponemos de un <span class="elsevierStyleItalic">gold standard</span> para el manejo del dolor postoperatorio tras una artroplastia total de rodilla, dado que se pueden administrar analgésicos a través de diferentes vías y ninguna de estas está exenta de riesgos. El sistema ideal de administración de analgésicos debería proporcionar dosis terapéuticas, no tóxicas, en el sitio quirúrgico, especialmente durante las primeras 72 h.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El cemento óseo utilizado en las artroplastias se ha usado como un medio de liberación de fármacos, especialmente antibióticos, desde 1970. Basado en este principio, se desarrolló este estudio con el objetivo de conocer el perfil de elución de dos anestésicos locales (hidrocloruro de lidocaína e hidrocloruro de bupivacaína) desde el cemento óseo de polimetilmetacrilato (PMMA).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron especímenes de cemento óseo Palacos® R + G e hidrocloruro de lidocaína o hidrocloruro de bupivacaína según el grupo de estudio. Estos especímenes se sumergieron en <span class="elsevierStyleItalic">phosphate buffered saline</span> (PBS) y se retiraron de la solución en diferentes cortes temporales establecidos. Posteriormente, se analizó la concentración de anestésico local en el líquido mediante cromatografía líquida.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El porcentaje de lidocaína eludida del cemento óseo PMMA de este estudio ha sido de 9,74% del contenido total de lidocaína por espécimen a las 72 h y de 18,73% a las 336 h (14 días). En el caso de la bupivacaína, el porcentaje de elución ha sido de 2,71% del contenido total de bupivacaína por espécimen a las 72 h y de 2,70% a las 336 h (14 días).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Los anestésicos locales eluyen <span class="elsevierStyleItalic">in vitro</span> desde el cemento óseo, alcanzando a las 72 h dosis cercanas a las dosis utilizadas en bloqueos anestésicos.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 616 "Ancho" => 755 "Tamanyo" => 23762 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Moulds for obtaining specimens.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1197 "Ancho" => 2175 "Tamanyo" => 153105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Elution procedure outline.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 133 "Ancho" => 2083 "Tamanyo" => 33057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Formula for expected LA concentration.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1254 "Ancho" => 2183 "Tamanyo" => 114735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Average lidocaine concentration (μg/ml) at each time point.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1240 "Ancho" => 2183 "Tamanyo" => 119968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Average bupivacaine concentration (μg/ml) at each time point.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hours \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lidocaine_A \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lidocaine_B \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lidocaine_C \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% elution \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">182.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">192.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">233.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">144.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">189.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">401.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">445.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">268.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">371.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">454.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">473.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">601.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">509.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">443.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">424.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">519.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">462.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">692.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">524 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">582.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">599.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">529.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">717.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">676.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">641.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">336 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1294.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1111.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1056.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1153.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3511655.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Concentration (μg/ml) and mean elution (%) of lidocaine.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hours \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bupivacaine_A \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bupivacaine_B \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bupivacaine_C \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% elution \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">127.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.9 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array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0150" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of knee and hip arthroplasty: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/1874325001105010080" "Revista" => array:6 [ "tituloSerie" => "Open Orthop J" "fecha" => "2011" "volumen" => "5" "paginaInicial" => "80" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21584277" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0155" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative pain treatment after total knee arthroplasty: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.P.H. Karlsen" 1 => "M. Wetterslev" 2 => "S.E. Hansen" 3 => "M.S. Hansen" 4 => "O. Mathiesen" 5 => "J.B. Dahl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0173107" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2017" "volumen" => "12" "paginaInicial" => "e0173107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28273133" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0160" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Best multimodal analgesic protocol for total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.A. Webb" 1 => "E.R. Mariano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/pmt.15.8" "Revista" => array:6 [ "tituloSerie" => "Pain Manag" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "185" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25971642" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0165" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pain management modalities after total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Terkawi" 1 => "D. Mavridis" 2 => "D.I. Sessler" 3 => "M.S. Nunemaker" 4 => "K.S. Doais" 5 => "R.S. Terkawi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000001607" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2017" "volumen" => "126" "paginaInicial" => "923" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28288050" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0170" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.D. Beswick" 1 => "V. Wylde" 2 => "R. Gooberman-Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2014-007387" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "e007387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25967998" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0175" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New and common perioperative pain management techniques in total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Elmallah" 1 => "J. Cherian" 2 => "T. Pierce" 3 => "J. Jauregui" 4 => "S. Harwin" 5 => "M. Mont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0035-1549027" "Revista" => array:6 [ "tituloSerie" => "J Knee Surg" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "169" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25892004" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0180" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pain control in total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Elmallah" 1 => "M. Chughtai" 2 => "A. Khlopas" 3 => "J. Newman" 4 => "K. Stearns" 5 => "M. Roche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0037-1604152" "Revista" => array:6 [ "tituloSerie" => "J Knee Surg" "fecha" => "2018" "volumen" => "31" "paginaInicial" => "504" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28719941" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0185" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depot local anesthetic in polymethylmethacrylate bone cement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.M. Bond" 1 => "J. Rudan" 2 => "S.M. Kobus" 3 => "M.A. Adams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00003086-200401000-00042" "Revista" => array:5 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2004" "volumen" => "418" "paginaInicial" => "242" "paginaFinal" => "245" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0190" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depot effects of various antibiotics mixed with Palacos resins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.W. Buchholz" 1 => "H. Engelbrecht" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chirurg" "fecha" => "1970" "volumen" => "41" "paginaInicial" => "511" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5487941" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0195" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PMMA cements" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.D. Kühn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/978-3-642-41536-4" "Libro" => array:3 [ "fecha" => "2013" "editorial" => "Springer" "editorialLocalizacion" => "Berlin, Heidelberg" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0200" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone cements. Up-to-date comparison of physical and chemical properties of commercial materials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.D. Kühn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2020" "editorial" => "Springer-Verlag" "editorialLocalizacion" => "Berlin, Heidelberg" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0205" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thein vitro elution of gentamicin sulfate from a commercially available gentamicin-loaded acrylic bone cement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Lewis" 1 => "S. Janna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jbm.b.30069" "Revista" => array:5 [ "tituloSerie" => "J Biomed Mater Res" "fecha" => "2004" "volumen" => "71B" "paginaInicial" => "77" "paginaFinal" => "83" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0210" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevo método de liberación de antibióticos del cemento óseo (polimetilmetacrilato): redefiniendo los límites" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Carbó-Laso" 1 => "P. Sanz-Ruiz" 2 => "J.C. del Real-Romero" 3 => "Y. Ballesteros-Iglesias" 4 => "E. Paz-Jiménez" 5 => "F. Arán-Ais" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recot.2017.08.001" "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2018" "volumen" => "62" "paginaInicial" => "86" "paginaFinal" => "92" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0215" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio experimental in vitro de la influencia de la adición de anestésicos locales en las propiedades de elución y trabajabilidad del cemento óseo de polimetilmetacrilato con gentamicina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Balaguer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2019" "editorial" => "Universitat Autònoma de Barcelona" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0220" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "AEMPS. Fitxa tècnica de lidocaïna. Available from: <a target="_blank" href="https://cima.aemps.es/cima/pdfs/es/ft/44793/FichaTecnica_44793.html.pdf">https://cima.aemps.es/cima/pdfs/es/ft/44793/FichaTecnica_44793.html.pdf</a>." ] ] ] 15 => array:3 [ "identificador" => "bib0225" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "AEMPS. Ficha técnica de bupivacaína. 2021." ] ] ] 16 => array:3 [ "identificador" => "bib0230" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Orthopaedic bone cement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Bridgens" 1 => "S. Davies" 2 => "L. Tilley" 3 => "P. Norman" 4 => "I. Stockley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.90B5.19803" "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2008" "volumen" => "90-B" "paginaInicial" => "643" "paginaFinal" => "647" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0235" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The bone-cement interface temperature during total joint replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.W. Reckling" 1 => "W.L. Dillon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1977" "volumen" => "59" "paginaInicial" => "80" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/833181" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0240" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesiology & critical care drug handbook: including select desease states & perioperative management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.L. Baughman" 1 => "J. Golembiewski" 2 => "W. Alvarez Jr.G.J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "paginaInicial" => "1821" "editorial" => "Lexi-Comp" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0245" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential sensitivity of fast and slow fibers in mammalian nerve III. Effect of etidocaine and bupivacaine on fast/slow fibers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Gissen" 1 => "B.G. Covino" 2 => "J. Gregus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "1982" "volumen" => "61" "paginaInicial" => "570" "paginaFinal" => "575" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6283948" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0250" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential slowing and block of conduction by lidocaine in individual afferent myelinated and unmyelinated axons" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Raymond Fink" 1 => "A.M. Cairns" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000542-198402000-00006" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1984" "volumen" => "60" "paginaInicial" => "111" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6696232" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0255" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversible conduction block in isolated toad sciatic nerve by emulsified isoflurane" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Li" 1 => "J. Yang" 2 => "J. Liu" 3 => "C.Y. Gong" 4 => "J. Gan" 5 => "X. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181d2732f" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "110" "paginaInicial" => "1024" "paginaFinal" => "1029" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20357146" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0260" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lidocaine blocking concentrations for B- and C-nerve fibers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.E. Heavner" 1 => "R.H. de Jong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000542-197403000-00004" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1974" "volumen" => "40" "paginaInicial" => "228" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4814244" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0265" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential sensitivities of mammalian nerve fibers to local anesthetic agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Gissen" 1 => "B.G. Covino" 2 => "J. Gregus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000542-198012000-00006" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1980" "volumen" => "53" "paginaInicial" => "467" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7457962" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0270" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential sensitivity to tetrodotoxin and lack of effect of prostaglandin E2 on the pharmacology and physiology of propagated action potentials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.J. Farrag" 1 => "S.K.P. Costa" 2 => "R.J. Docherty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bjp.0704607" "Revista" => array:6 [ "tituloSerie" => "Br J Pharmacol" "fecha" => "2002" "volumen" => "135" "paginaInicial" => "1449" "paginaFinal" => "1456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11906958" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0275" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Susceptibility to lidocaine of impulses in different somatosensory afferent fibers of rat sciatic nerve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.H. Huang" 1 => "J.G. Thalhammer" 2 => "S.A. Raymond" 3 => "G.R. Strichartz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pharmacol Exp Ther" "fecha" => "1997" "volumen" => "282" "paginaInicial" => "802" "paginaFinal" => "811" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9262344" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0280" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential nerve block by bupivacaine and 2-chloroprocaine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.H. Rosenberg" 1 => "E. Heinonen" 2 => "S.-E. Jansson" 3 => "J. Gripenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/52.12.1183" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "1980" "volumen" => "52" "paginaInicial" => "1183" "paginaFinal" => "1189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7448098" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0285" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ensaio mecânico da resistência ao impacto do cimento ósseo puro e associado a duas drogas anestésicas locais" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Giordano" 1 => "H. Rios" 2 => "M. Moreirão" 3 => "M. Giordano" 4 => "N.P.d. Amaral" 5 => "A. Pallottino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Ortop" "fecha" => "2007" "volumen" => "42" "paginaInicial" => "225" "paginaFinal" => "230" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0290" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymethylmethacrylate bone cement: effect of ropivacaine local anaesthetic on mechanical properties" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Lotfi" 1 => "E. Hughes" 2 => "R. McCulloch" 3 => "C. Horner" 4 => "D. Shepherd" 5 => "L. Grover" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/1358-992X.20205042" "Revista" => array:5 [ "tituloSerie" => "Orthop Procs" "fecha" => "2020" "volumen" => "102-B" "numero" => "Suppl. 5" "paginaInicial" => "42" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18884415/0000006700000005/v3_202404150741/S1888441523001558/v3_202404150741/en/main.assets" "Apartado" => array:4 [ "identificador" => "7694" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/18884415/0000006700000005/v3_202404150741/S1888441523001558/v3_202404150741/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441523001558?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2024 October | 17 | 5 | 22 |
| 2024 September | 39 | 6 | 45 |
| 2024 August | 32 | 8 | 40 |
| 2024 July | 21 | 6 | 27 |
| 2024 June | 19 | 7 | 26 |
| 2024 May | 10 | 8 | 18 |
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| 2024 March | 26 | 4 | 30 |
| 2024 February | 22 | 6 | 28 |
| 2024 January | 18 | 6 | 24 |
| 2023 December | 27 | 12 | 39 |
| 2023 November | 22 | 11 | 33 |
| 2023 October | 54 | 12 | 66 |
| 2023 September | 74 | 10 | 84 |
| 2023 August | 4 | 0 | 4 |
| 2023 July | 40 | 33 | 73 |
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