Local anaesthetics and chondrotoxicty: What is the evidence?

Purpose Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years. Methods We have reviewed the available basic scie...

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Bibliographic Details
Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2012-11, Vol.20 (11), p.2294-2301
Main Authors: Baker, Joseph F., Mulhall, Kevin J.
Format: Article
Language:English
Subjects:
Analgesics
Anesthetics, Local - administration & dosage
Anesthetics, Local - adverse effects
Animals
Cartilage, Articular - cytology
Cell culture
Cell Death - drug effects
Cell Line
Cell Survival - drug effects
Cells, Cultured
Chondrocytes - drug effects
Culture Media
Dose-Response Relationship, Drug
Epinephrine - administration & dosage
Glucocorticoids - administration & dosage
Humans
Hydrogen-Ion Concentration
Knee
Knees
Medicine
Medicine & Public Health
Morphine
Orthopedics
Recruiting
Science
Sports
Surgery
Theatre
Toxicity
Work
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Summary:Purpose Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years. Methods We have reviewed the available basic science literature focusing on the studies assessing the effect of exposing articular chondrocytes to local anaesthetic agents. We attempt to highlight the key findings and, where possible, extrapolate the laboratory findings to the operating theatre. Results Basic science reports are analysed according to their setting of either in vitro, ex vivo or in vivo and according to cell line. A majority of work to date has been done using in vitro models. Only a small number of in vivo models using animal cell lines have been used and the best of these have conflicting results with regard lasting toxicity secondary to local anaesthetic exposure. Conclusions Numerous reports suggest a toxic effect of local anaesthetic agents on articular chondrocytes, however, further work is warranted to establish the precise mechanism of toxicity and whether or not single bolus administration results in long-term deleterious outcomes. Determining the ideal in vitro model will help in extrapolating laboratory data to the operating theatre.
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-011-1804-6