IRAP (intravenous regional antibiotic prophylaxis)

John Schou, M.D., Hans Rudolf Henche, M.D., Ph.D.and Hans-Peter Herion M.D.

A new technique for perioperative antibiotic prophylaxis is described, in which netilmicin (200 mg in 100 ml isotonic saline for the leg and half of that dose for the arm) is injected in a bloodless field. This is obtained when anyhow a tourniquet is used for operation on an extremity. Through this technique, high but varying concentrations of the antibiotic was obtained in the three tissue specimens (average 33.1 µg/ml in fat, 80.3 µg/ml synovia and 24.5 µg/ml bone) obtained during surgery for knee arthroplasty. A secondary effect is obtained after release of the tourniquet, when the majority of netilmicin enters the systemic blood stream and is redistributed with a level of 5.65 ± 1.7 µg/ml after 30 minutes. The clinical efficacy of this approach to reduce postoperative orthopedic infection rates remains to be proved.

Read more about this concept, since 1995 in regular use in our orthopedic department, in Dr. Herion's dissertation (in German)

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