Article DetailsContinuous Lidocaine Toxic to the Shoulder Joints |
| Date Added: April 05, 2010 11:02:28 AM |
| Author: Thor Anderson |
| Category: Health |
| Pain control after arthroscopic surgery is a hot topic within the medical community and for good reason. Many doctors do not want to prescribe addictive pain killers to their patients when there is a better alternative. One popular alternative is to use a pain management pump that the patient uses to deliver medication to the surgical site. Unfortunately, there is some evidence to suggest that some of these pumps are actually causing damage to the cartilage. One interesting study is called, “Lidocaine Potentiates the Chondrotoxicity of Methylprednisolone” by V. Seshadri, C. Coyle, C. Chu - Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 25, Issue 4, Pages 337-347. Here is an excerpt: “Abstract – Purpose - This study examined the viability of bovine articular chondrocytes after exposure to methylprednisolone, methylprednisolone with lidocaine, and methylprednisolone in a simulated inflammatory environment. Methods Bovine articular chondrocytes were suspended in alginate beads and cultured in Dulbecco's modified Eagle's medium/F-12 for 1 week before experimentation. Suspended chondrocytes were exposed to 0.9% saline solution (negative control), methylprednisolone (4, 8, and 16 mg/mL), methylprednisolone (8 mg/mL) with 1% lidocaine, or methylprednisolone (8 mg/mL) and saline solution in a simulated inflammatory environment (interleukin [IL] 1ß exposure, 10 ng/mL) for 15, 30, and 60 minutes. Flow cytometry was performed 1 day, 4 days, and 7 days after exposure by use of annexin V and propidium iodide to assess chondrocyte viability. Conclusions These results show a dose- and time-dependent decrease in chondrocyte viability after exposure to clinically relevant doses of methylprednisolone. The combination of methylprednisolone and lidocaine was toxic, with virtually no cells surviving after treatment. In addition, methylprednisolone did not mitigate the inflammatory effects of IL-1ß; rather, it further potentiated the chondrotoxicity. Clinical Relevance Intra-articular injections of corticosteroids and local anesthetics are widely used in clinical practice. This in vitro study provides information on the potential effects of these drugs on articular cartilage.” Another interesting study is called, “Continuous Infusion of a Local Anesthetic Versus Interscalene Block for Postoperative Pain Control After Arthroscopic Shoulder Surgery Arthroscopy” by : D. Webb, D. Guttmann, P. Cawley, J. Lubowitz - The Journal of Arthroscopic & Related Surgery, Volume 23, Issue 9, Pages 1006-1011. Here is an excerpt: “Abstract - Purpose: The purpose of this investigation was to evaluate the efficacy, complication rate, and cost of a 1-time interscalene block compared with a continuous infusion of a local anesthetic for postoperative pain relief in patients having arthroscopic shoulder surgery. Methods: After prospective power analysis and institutional review board approval, 56 consecutive patients having arthroscopic shoulder surgery under general anesthesia performed by a single surgeon were randomly assigned to 1 of 2 groups to evaluate postoperative pain control. Group 1 patients received a preoperative interscalene block, and group 2 patients received a subacromial continuous infusion of a local anesthetic (0.5% bupivacaine) via a pain pump for 48 hours postoperatively. Pain was evaluated at 12, 24, 36, and 48 hours and then daily on postoperative days 3 through 7 by use of a visual analog scale included in a patient diary. Patients were provided with 2 “rescue” medication options: ibuprofen and Percocet (Endo Pharma ceuticals, Chadds Ford, PA). The total number of tablets ingested was also evaluated over these same intervals. Total hospital outpatient surgical costs for each group were calculated by dividing total hospital charges by the ratio of annual hospital cost to charges. Results: No statistically significant differences were identified between the 2 groups with regard to visual analog scale pain scores, medication intake, or cost. Complications did not occur in either group. One patient inadvertently removed the pain pump catheter. Conclusions: Our results support the null hypothesis. We found no difference between interscalene block versus continuous subacromial infusion of a local anesthetic with regard to efficacy, complication rate, or cost. Level of Evidence: Level I, prospective, randomized controlled trial.” If you found either of these studies interesting, please read them in their entirety. We all owe these researchers a debt of gratitude for their work. Thor Anderson is the author of this article on Pain Pump Lawsuit. Find more information about Painbuster Lawsuit here. |
