Background Acute kidney injury (AKI) may complicate up to 10% of primary lower-extremity total joint arthroplasties. However, none of these previous studies evaluated the duration and reversibility of AKI. Moreover, none specifically evaluated the impact of perioperative celecoxib on the incidence and severity of AKI, especially for patients with preexisting renal impairment. The aim of this study was to retrospectively review the incidence, severity and duration of AKI with short term perioperative celecoxib. We also aimed to evaluate the impact of perioperative celecoxib on the incidence and severity of AKI in patients with and without preexisting renal impairment. Methods We retrospectively reviewed 1077 patients at Queen Mary Hospital, Hong Kong, from January 2018 to December 2021. Data were retrieved from the computerized medical records system. Results One hundred of 1077 patients (9.3%) had postoperative AKI. Eight hundred eighty-eight patients (82.5%) were prescribed perioperative celecoxib, while 189 patients (17.5%) were not. The overall incidence of AKI in those taking perioperative celecoxib was 9.2%, while it was 9.5% in those not taking perioperative celecoxib. There was no statistically significant difference. There was no association between perioperative celecoxib and postoperative AKI. Among those who received perioperative celecoxib, the overall incidence of postoperative AKI in those with and without preexisting renal impairment was 9.3% and 9.2%, respectively. This was not statistically significant. The duration of AKI was 4 days for both groups. In both groups, most AKI cases were stage 1. Conclusions Short term perioperative celecoxib probably had no additional AKI risk even in patients with preexisting renal impairment. Trial Registration ClinicalTrials.gov registration number NCT05595694. Trial Registration ClinicalTrials.gov registration number NCT05595694

Background Periarticular local infiltration of analgesia (LIA) and regional nerve block using adductor canal block (ACB) have been effective in managing postoperative pain for total knee arthroplasty (TKA). It has been shown that combining ACB with LIA can significantly reduce pain scores and morphine consumption compared with LIA alone. However, this raises concerns about the potential risk of local anesthetic systemic toxicity (LAST), especially with the large doses of total local anesthetic used in both LIA and ACB. This study was to evaluate the plasma level of bupivacaine over a 72-hour period following ACB using 66.5 mg of liposomal bupivacaine (LB) in patients undergoing TKA with LIA using 300 mg ropivacaine. Methods This was a prospective observational study. Ten patients undergoing primary, unilateral, simple revision TKA in a tertiary hospital in Hong Kong between December 2020 to February 2022 were included in the study. The primary outcomes were the time to peak plasma concentration (Tmax) of bupivacaine and the peak plasma concentration (Cmax) of bupivacaine. The secondary outcome was the presence of LAST. Results Tmax of bupivacaine was 48 hours while Cmax of bupivacaine was 88 mcg/L, this value was far below 2000 mcg/L, the defined toxic plasma concentration of bupivacaine. Conclusions There is still room for increasing the dose of LB used in ACB for TKA patients, further dose-defining studies with PK data are needed to define the optimal dose that would balance the safety and efficacy of LB. Trial registration The clinical trial was registered at ClinicalTrials.gov with registration number NCT04916392.

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