| Arthroscopic surgery is a pretty standard | | | | Williams, B. Bach, B. Cole - Arthroscopy: The Journal |
| procedure. In fact, over 600,000 arthroscopic | | | | of Arthroscopic & Related Surgery, Volume 22, Issue |
| surgeries are performed each year. Although every | | | | 8, Pages 813-819. |
| surgery comes with inherent risks, it has come as a | | | | Here is an excerpt: "Abstract - Purpose: |
| huge surprise that some people have lost cartilage in | | | | Postoperative pain pumps are increasingly used to |
| their shoulder after undergoing such a routine surgical | | | | deliver a continuous infusion of local anesthetic into |
| procedure. This cartilage loss is technically called | | | | the surgical wound or the joint. Recently, there have |
| postarthroscopic glenohumeral chondrolysis. In some | | | | been concerns that the use of such devices may be |
| cases it can result in the need for a complete | | | | associated with chondrotoxicity and even cases of |
| shoulder replacement. Understanding what causes | | | | chondrolysis in the shoulder. An experimental model is |
| this condition is very important, and there has been | | | | presented that investigates potential chondrotoxic |
| some outstanding research done in the area. | | | | effects of a continuous intra-articular infusion of |
| One study worth mentioning is called, "Severe | | | | bupivacaine in the rabbit shoulder. Methods: We |
| chondrolysis after shoulder arthroscopy: A case series | | | | divided 30 rabbits into 3 groups that received |
| " by David S. Bailie, MDa, Todd S. Ellenbecker Volume | | | | continuous infusions of either saline solution, |
| 18, Issue 5, Pages 742-747 (September 2009). Here | | | | bupivacaine, or bupivacaine with epinephrine into the |
| is an excerpt:" Hypothesis - Chondrolysis has been | | | | glenohumeral joint over a period of 48 hours. Animals |
| observed after shoulder arthroscopy and results in | | | | were killed after 1 week, and osteochondral and |
| severe glenohumeral complications. | | | | synovial samples from the glenohumeral joint |
| Materials and methods - Twenty three cases of | | | | underwent analyses with confocal microscopy for live |
| post-arthroscopic glenohumeral chondrolysis, occurring | | | | dead cell assay, metabolic sulfate uptake assessment, |
| between 2005-2006, are reported following a variety | | | | and conventional histologic analysis. Results: Infusion |
| of arthroscopic shoulder procedures. Presenting | | | | of bupivacaine with epinephrine and without |
| complaints, signs and symptoms, associated | | | | epinephrine decreased sulfate uptake by 56% (P = |
| operative findings, and potential etiological factors are | | | | .009) and 50% (P = .02), respectively, when |
| reviewed. Management options are summarized. | | | | compared with saline solution; cell viability decreased |
| – Discussion - This case series identifies several | | | | by 20% (P = .08) and 32% (P = .02), respectively. |
| common factors that could be responsible for | | | | Histologic analysis yielded significantly worse scores |
| post-arthroscopic glenohumeral chondrolysis. No single | | | | for bupivacaine infusion with epinephrine (P = .004) |
| mechanism can be implicated based on the results of | | | | and without epinephrine (P = .02). The results for |
| this study. Although strong concerns are raised over | | | | bupivacaine with or without epinephrine were not |
| the use of intra-articular local anesthetics, | | | | significantly different. Conclusions: Continuous |
| glenohumeral chondrolysis appears to be an | | | | intra-articular infusion of bupivacaine with and without |
| unfortunate convergence of multiple factors that | | | | epinephrine led to significant histopathologic and |
| may initiate rapid dissolution of articular cartilage and | | | | metabolic changes in articular cartilage. Clinical |
| degenerative changes. Conclusion - Chondrolysis is | | | | Relevance: Bupivacaine showed profound |
| a devastating complication of arthroscopic shoulder | | | | chondrotoxic effects in an experimental model that |
| surgery that can result in long-term disabling | | | | closely followed the current clinical application of |
| consequences. Further research is required to | | | | postoperative pain pumps. The results caution against |
| specifically identify causative factors. Until this is a | | | | the use of such devices in applications for smaller |
| available, we strongly advise against the use of large | | | | joints with minimal clearance or dilution as a result of |
| doses of intra-articular placement of local anesthetics." | | | | hematoma, where continuous exposure of cartilage |
| Another good study is called, "Chondrolysis After | | | | to bupivacaine is expected." |
| Continuous Intra-Articular Bupivacaine Infusion: An | | | | If you found either of these studies interesting, |
| Experimental Model Investigating Chondrotoxicity in | | | | please read them in their entirety. This article should |
| the Rabbit Shoulder" by A. Gomoll, R. Kang, J. | | | | not be construed as medical advice. |