| or a loved one received a pain medication pump or | | | | can be used either in the subacromial space or within |
| pain ball after shoulder surgery and have developed | | | | the glenohumeral joint. Several clinical studies |
| cartilage loss in the shoulder, you may have a legal | | | | suggested?which was confirmed by a bovine and |
| claim against the manufacturer. | | | | rabbit cartilage study?that there is significant |
| Several well respected medical journals have | | | | chondrotoxicity from bupivacaine, a local anesthetic |
| established a link between the use of intra articular | | | | commonly used in pain pumps. Postarthroscopic |
| shoulder pain pumps and a horrible condition called | | | | glenohumeral chondrolysis is a noninfectious entity |
| Postarthroscopic Glenohumeral Chondrolysis (PAGCL). | | | | associated with factors including use of |
| By utilizing these pumps, doctors are able to inject a | | | | radiofrequency thermal instruments and intra-articular |
| continuous stream of pain killers into the shoulder to | | | | pain pumps that administer bupivacaine, but there |
| help the patient with pain management. | | | | have been no cases reported with subacromial pain |
| Unfortunately, the medication is toxic to the shoulder | | | | pump placement. Treatment options are difficult in a |
| joint and can result in the deterioration of cartilage | | | | young patient with postarthroscopic glenohumeral |
| and ultimately a shoulder replacement. | | | | chondrolysis, and understanding the literature with |
| On November 13, 2009, the FDA announced that it is | | | | regard to risk factors is paramount to counseling |
| requiring the drug manufacturers to update their | | | | patients and preventing this devastating complication." |
| product labels to warn healthcare professionals about | | | | Another interesting study is titled Intra-articular |
| this potential serious adverse effect. | | | | bupivacaine: potentially chondrotoxic? |
| What are the symptoms of PAGCL? | | | | Published by Oxford University Press on behalf of |
| Symptoms typically show up after several months | | | | The Board of Directors of the British Journal of |
| from the surgery. You might notice that you are | | | | Anaesthesia. |
| having difficulty with mobility and reduced range of | | | | S. T. Webb and S. Ghosh |
| motion. Others have complained about hearing a | | | | Department of Anaesthesia and Intensive Care |
| bothersome clicking sound. In some of the worse | | | | Papworth Hospital NHS Foundation Trust |
| cases, the shoulder makes a grinding and popping | | | | Cambridge |
| sound and is extremely painful. | | | | UK |
| One interesting study: Pain Pump Use After Shoulder | | | | "The management of acute postoperative pain after |
| Arthroscopy As a Cause of Glenohumeral | | | | orthopaedic surgery is a challenge for anaesthetists |
| Chondrolysis | | | | and surgeons. The administration of local anaesthetic |
| Arthroscopy: The Journal of Arthroscopic & Related | | | | drugs into the joint space, either by single injection or |
| Surgery, Volume 25, Issue 6, Pages 647-652 | | | | by continuous infusion, has become a well-recognized |
| B. Busfield, D. Romero | | | | technique for postoperative analgesia, in particular |
| Here is an excerpt: | | | | after arthroscopic surgery. Bupivacaine is commonly |
| "Shoulder arthroscopy has become a routine | | | | used for intra-articular analgesia because of its long |
| outpatient surgery. Pain control is a limiting factor for | | | | duration of action. Other local anaesthetics used for |
| patient discharge after surgery, and several modalities | | | | intra-articular analgesia include ropivacaine and |
| are used to provide continued analgesia | | | | lidocaine. Intra-articular use of these drugs has been |
| postoperatively. Regional anesthetic blocks and | | | | widely regarded as safe, and adverse effects of local |
| shoulder pain pumps are common methods to | | | | anaesthetic agents in the joint space have been |
| provide short-term pain control. Shoulder pain pumps | | | | reported only rarely. |