Comparison of intra-articular low-dose sufentanil, ropivacaine, and combined sufentanil and ropivacaine on post-operative analgesia of isolated anterior cruciate ligament reconstruction

Abstract

Randomized controlled trial, Level I.

Ropivacaine alters the mechanical properties of hamstring tendons: In vitro controlled mechanical testing of tendons from living donors

“…Our results on the effects of RI on the mechanical properties of tendon tissue tend to support in vitro findings of cell toxicity [5,7,8,11,13]. Piper and Kim [8] were the first to describe the toxic effects of local anesthetics (bupivacine) on human chondrocytes in vitro; however, RI did not increase cell apoptosis in comparison to the control saline solution.…”

“…Although RI did not affect tendon elongation relative to a saline solution. In comparison to published results describing the load at failure of tendons harvested from cadavers [5,19], our values appear low; however, our results correspond to the mechanical properties of isolated tendons tested in a similar configuration (3 cm length) without reinforcement (i.e., suture). In addition, we used fresh tendons from living donors, while most tests were done with animal or cadaver specimens [17][18][19][20].…”

“…Postoperative pain after joint surgery, whether performed by arthroscopy or as an open procedure, is a major concern for patients and surgeons [1][2][3]. While there are no studies specifically recommending intraarticular injection of local anesthetics, ropivacaine (RI) is often injected inside or around the joint, or administered by the perineural route to manage pain [3][4][5]. RI is an amide local anesthetic (LA).…”

In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications

“…1,21,31 While we cannot generalize our findings regarding the chondrotoxicity of the single-dose administration of ketorolac to all available NSAIDs, our results suggest caution in the intra-articular use of this medication class, as a potential risk of clinically important chondrotoxicity exists. In contrast, the intraarticular administration of the opioid analgesics morphine and fentanyl, which have been used extensively for pain relief after surgical intervention in a variety of joints, 15,23,40,58 demonstrated no significant chondrotoxicity in our single-injection model and may serve as an important part of multimodal pain control regimens. We caution against the inclusion of meperidine for intraarticular use.…”

“…33 The use of intra-articular NSAIDs and opioid medications has been shown to be clinically 5-in-5 effective in decreasing pain in patients for both operative and nonoperative indications. § Although these medications are often injected into joints for musculoskeletal pain relief, particularly for postoperative relief in the knee 48,49,57,58 as well as in the treatment of impingement and adhesive capsulitis within the shoulder, 1,39 there is minimal information regarding the potential chondrotoxicity of NSAIDs and opioid medications prescribed as a single dose. While a small number of investigations have demonstrated minimal chondrotoxicity with the use of morphine and fentanyl, 3,13,54 reports on the effect of ketorolac on articular cartilage have been contradictory, 4,51 and no data are known to exist regarding meperidine.…”