For Periarticular Injection

(Ropivacaine, Epinephrine, Clonidine, & Ketorolac in Sodium Chloride Solution, 50 ml Fill, 50 ml Syringe

R.E.C.K injection is a patented, non-opioid, ready-to-administer solution for periarticular injection containing the following active ingredients:

  • 123 mg (2.46mg/mL) Ropivacaine HCl
  • 0.25 mg (0.005mg/mL) Epinephrine
  • 0.04 mg (0.0008mg/mL) Clonidine HCl
  • 15 mg (0.3mg/mL) Ketorolac Tromethamine

These ingredients are combined in a solution of sodium chloride to provide a total volume of 50 mL per ready-to-administer syringe. 100 mL total dose2 is achieved with two 50 ml syringes. It should be stored at room temperature, and protected from light.

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R.E.C.K. (Ropivacaine, Epinephrine, Clonidine, Ketorolac) in Sodium Chloride Solution, 50 ml fill, 50 ml Syringe
API to Sterile

Benefits of the R.E.C.K injection include:

The ready-to-administer syringe makes it easy for the operating room team to decant from the syringe and draw up into the surgeon's preferred syringe and needle combination. Other benefits include::
  • Supports local infiltration anesthesia which is a mainstay of multimodal pain management
  • Eliminates the need to compound in the hospital or mix products in the O.R. 90-day beyond use date helps reduce waste
  • Supplied by an FDA registered 503B outsourcing facility
  • Shipped directly to your hospital pharmacy and available in all 50 states


How to use R.E.C.K

 R.E.C.K solution is a sterile solution and comes in a pre-filled, ready-to-administer container to save time and reduce waste. OR team members can simply decant the product into a sterile container and draw it up into their preferred combination of syringe and needle. They can then administer R.E.C.K as a periarticular injection.

An injection of ropivacaine, epinephrine, clonidine and ketorolac (R.E.C.K) is used as part of a multimodal pain regimen as a way to minimize postoperative pain and support patients’ recovery from their surgery.  Poor pain management can increase the cost of care, lead to lengthier hospital stays, reduce functional outcomes, result in chronic pain syndromes, side effects from chronic analgesic and opioid use. Please see this The Journal of Arthroplasty  prospective, randomized, double-blind study for appropriate use of R.E.C.K.

Multimodal Pain Management Multimodal therapy is the preferred approach to postoperative pain control for knee replacement surgery, meaning practitioners use Local Infiltrative Analgesia (LIA) cocktail formulations such as R.E.C.K to minimize pain. For example, patients can receive a combination of celecoxib, hydrocodone, gabapentin, acetaminophen, Solu-Cortef, oxycodone, tramadol, ketorolac, and/or hydromorphone.

Here are a few resources that discuss this approach:

  1. https://www.drlikover.com/resources/learn-pain-reduction/
  2. Kelley, Todd C et al. “Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study.” The Journal of arthroplasty vol. 28,8 (2013): 1274-7.
  3. Dalury DF. A state-of-the-art pain protocol for total knee replacement. Arthroplast Today. 2016 Feb 12;2(1):23-25.
  4. Jonathan R. Danoff, Rahul Goel, R. Andrew Henderson, James Fraser, Peter F. Sharkey.Periarticular Ropivacaine Cocktail Is Equivalent to Liposomal Bupivacaine Cocktail in Bilateral Total Knee Arthroplasty.The Journal of Arthroplasty.2018 Aug 33;8:2455-2459.