Article

Chondrolysis After Continuous Intra-Articular Bupivacaine Infusion: An Experimental Model Investigating Chondrotoxicity in the Rabbit Shoulder

Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Chicago, Illinois 60612, USA.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 09/2006; 22(8):813-9. DOI: 10.1016/j.arthro.2006.06.006
Source: PubMed

ABSTRACT Postoperative pain pumps are increasingly used to deliver a continuous infusion of local anesthetic into the surgical wound or the joint. Recently, there have been concerns that the use of such devices may be associated with chondrotoxicity and even cases of chondrolysis in the shoulder. An experimental model is presented that investigates potential chondrotoxic effects of a continuous intra-articular infusion of bupivacaine in the rabbit shoulder.
We divided 30 rabbits into 3 groups that received continuous infusions of either saline solution, bupivacaine, or bupivacaine with epinephrine into the glenohumeral joint over a period of 48 hours. Animals were killed after 1 week, and osteochondral and synovial samples from the glenohumeral joint underwent analyses with confocal microscopy for live/dead cell assay, metabolic sulfate uptake assessment, and conventional histologic analysis.
Infusion of bupivacaine with epinephrine and without epinephrine decreased sulfate uptake by 56% (P = .009) and 50% (P = .02), respectively, when compared with saline solution; cell viability decreased by 20% (P = .08) and 32% (P = .02), respectively. Histologic analysis yielded significantly worse scores for bupivacaine infusion with epinephrine (P = .004) and without epinephrine (P = .02). The results for bupivacaine with or without epinephrine were not significantly different.
Continuous intra-articular infusion of bupivacaine with and without epinephrine led to significant histopathologic and metabolic changes in articular cartilage.
Bupivacaine showed profound chondrotoxic effects in an experimental model that closely followed the current clinical application of postoperative pain pumps. The results caution against the use of such devices in applications for smaller joints with minimal clearance or dilution as a result of hematoma, where continuous exposure of cartilage to bupivacaine is expected.

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    • "In an in vivo rabbit study three groups recieved continuous infusions of either saline, bupivacaine or bupivacaine with epinephrine over 48 hours(Gomoll et al., 2006). One week after treatment the animals were sacrificed and osteochondral and synovial samples analysed. "
    Pain Management - Current Issues and Opinions, 01/2012; , ISBN: 978-953-307-813-7
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    • "L'utilisation de ces techniques anesthésiques locales ou locorégionales doit cependant se faire avec vigilance. Dans de récentes publications, plusieurs cas de chondrolyse glénohumérale postarthroscopique ont été décrits 15—17, dont la cause incriminée pourrait être l'utilisation d'anesthésiques locaux péri-ou intra-articulaire, comme semblent le faire penser certains travaux sur modèles animaux [18] [19]. Dans notre étude, cette complication a systématiquement été recherchée chez tous les patients et n'a été retrouvée dans aucun cas. "
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    • "Numbers are not mutually exclusive if articles examined multiple anesthetics. The sources were as follows: Dogan et al. 27 (2004), Chu et al. 28 (2006), Gomoll et al. 30 (2006), Hansen et al. 39 (2007), Busfield et al. 41 (2008), Chu et al. 29 (2008), Dragoo et al. 36 (2008), Greis et al. 40 (2008), Karpie and Chu 33 (2007), Piper and Kim 31 (2008), Bailie and Ellenbecker 9 (2009), Gomoll et al. 32 (2009), McNickle et al. 8 (2009), Saltzman et al. 38 (2009), and Seshadri et al. 34 (2009). (Bup, bupivacaine; Epi, epinephrine; Lido, lidocaine.) "
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