In Vivo Effects of a Single Intra‐Articular Injection of 2% Lidocaine or 0.5% Bupivacaine on Articular Cartilage of Normal Horses

Abstract

These results reveal an anabolic effect of single IA injections of local anesthetics on cartilage metabolism. Although collagen degradation biomarker results were not increased, it is possible that the anabolic response is because of an undetected cartilage insult, and requires further investigation.

Plasma and synovial fluid concentrations and cartilage toxicity of bupivacaine following intra‐articular administration of a liposomal formulation to horses

“…This was evidenced by significant increases in markers of collagen synthesis and aggrecan turnover and no changes in markers of collagen degradation [11]. The investigators in the latter study theorised that the lack of chondrotoxicity noted in vivo, compared to that reported in cell culture [10], might be a result of dynamically changing joint bupivacaine concentrations that is observed under in vivo conditions [11].…”

“…Although their use may be fairly common, there are reports of chondrotoxicity associated with IA use of local anaesthetics [3][4][5][6][7][8][9]. The effects of IA bupivacaine on chondrocytes in vitro and in vivo have been mixed with some studies reporting chondrodestruction and others reporting no adverse effects [3][4][5][6][7][8][9][10][11]. For example, Park and colleagues concluded that bupivacaine may induce detrimental chondrotoxicity when administered intra-articularly based on in vitro cell viability numbers following exposure of equine chrondrocytes to 0.5% bupivacaine [10].…”

Intra‐articular administration of lidocaine in anaesthetized dogs: pharmacokinetic profile and safety on cardiovascular and nervous systems

“…After an in vivo study on the effects of IA lidocaine on horse cartilage, Piat et al . () concluded that a single IA administration in normal joints is safe.…”

Pain

“…Efficacy may be affected by low tissue pH as with inflammation 50 ; although adverse effects are limited, detrimental effects on articular cartilage are reported and warrant further investigation. 51 When systemically administered, data support lidocaine's anti-inflammatory and analgesic effects 50 ; however, because of its short action it must be given by IV infusion. If dosed inappropriately, systemic administration of lidocaine can result in hypotension, seizures, and collapse; bupivacaine is not recommended for systemic IV use because of reported cardiovascular toxicity.…”