Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain Pump Catheter After Arthroscopic ACL Reconstruction

Buchko, Jordan Z.; Gurney-Dunlop, Tanner; Shin, Jason J.

doi:10.1177/0363546514555667

Cited by 33 publications

(20 citation statements)

References 34 publications

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“…Several surgical procedures have been analyzed, including Total Hip Arthroplasty (THA), Total Knee Arthroplasty (TKA), ankle and foot surgery, burn reconstructive surgery, lower limb revascularization or amputation. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Regarding THA, Fusco et al have conducted a doubleblind, randomized, controlled study with 96 patients. The patients were randomized to receive either a local infiltration analgesia and continuous wound infusion of 0.2% levobupivacaine (experimental group) or a local infiltration analgesia and continuous wound infusion of saline solution.…”

Section: Lower Limb Surgerymentioning

confidence: 99%

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<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patientcontrolled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.

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Section: Lower Limb Surgerymentioning

confidence: 99%

“…5 Another side effect could be represented by knee chondrolysis when continuous intra-articular infusion of bupivacaine, with or without epinephrine, is set postoperatively. 9,14 As regards the use of CWI for arthroscopic procedures, there are insufficient or not validated data in Literature.…”

Section: Lower Limb Surgerymentioning

confidence: 99%

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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“…We did not observe any case of infection or delayed wound healing in the LIA group. Chondrolysis after continuous intra-articular infusion of ropivacaine [27] and most commonly bupivacaine [28, 29] has been reported and it is another potential source of concern. Although we acknowledge that our study has a relatively low number of patients to address safety concerning chondrolysis, none of the 20 patients treated with our LIA protocol developed such complication.…”

Section: Discussionmentioning

confidence: 99%

Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents

Novais¹,

Kestel²,

Carry³

et al. 2018

Journal of Pediatric Orthopaedics

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Background Open treatment of femoroacetabular impingement (FAI) through a surgical hip dislocation (SHD) approach has been reported to allow for improvement in pain and function. However, the approach require a trochanteric osteotomy and may be associated with high level of pain after surgery. Currently, there is no systematic approach for pain management after SHD for treatment of FAI. Methods A retrospective chart review was used to collect data from 121 subjects (12 to ≤21 years old) who received periarticular local infiltration analgesia (LIA, n=20), epidural analgesia (n=72), or intravenous patient-controlled analgesia (PCA, n=29) after SHD from January 2003 to June 2014. Verbal pain scores, opioid consumption, incidence of side effects/complications, and length of hospital stay (LOS) were recorded. All non-opioid medications with analgesic potential were included in the statistical models as potential confounding variables Results Twelve hours after surgery, the odds of moderate/severe pain were higher in the PCA group [Odds Ratio: 20.5, 95% CI: 1.7 to 243.8, p = 0.0166] and epidural group [Odds Ratio: 5.2, 95% CI: 0.7 to 92.0, p = 0.3218] compared to the LIA group. There was no difference in pain scores across all groups one [p=0.0675] or 24 hours [p=0.3473] postoperatively. Total opioid consumption in the LIA group was 59.8% [95%CI: 15.0 to 81.0%%, p=0.0175] lower than the total opioid consumption in the Epidural group and 60.7% [95% CI:17.3 to 81.3, p = 0.0144] lower than the total opioid consumption in the PCA group. Hospital length of stay was increased in the epidural [Mean Difference: 22.1, 95% CI: 6.8 to 37.4 hrs, p = 0.0051] and PCA [Mean Difference: 16 hours, 95% CI: 1 to 31.5 hrs, p = 0.0367] groups relative to the LIA group. There were 0 (0%) complications in the LIA group compared to 11 (15.3%) in the epidural group. Conclusion Local infiltration analgesia was more effective at controlling pain 12 hours after surgery in comparison to PCA with similar pain control to epidural. LIA was associated with significantly lower need for opioids and shorter LOS compared to the PCA and epidural protocols. Periarticular infiltration should be considered for pain management after SHD for treatment of FAI in adolescents. Level of Evidence III-Retrospective Comparative Study

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“…A potential criticism of this technique is the fear that intra‐articular local anaesthetic agents, particularly bupivacaine, can be chondrotoxic in a time and dose‐dependent manner . This damage can lead to chondrolysis, particularly if postoperative catheter infusions are used . Indeed, reports of irreversible joint damage, especially in a cohort of patients in whom long‐term joint function is critical, may represent the biggest drawback of this strategy.…”

Section: Analgesic Strategiesmentioning

confidence: 99%

Analgesic strategies for day‐case knee surgery

Wojcikiewicz

El‐Boghdadly

2019

Anaesthesia

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Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain Pump Catheter After Arthroscopic ACL Reconstruction

Cited by 33 publications

References 34 publications

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Local Infiltration Analgesia Compared With Epidural and Intravenous PCA After Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Adolescents

Analgesic strategies for day‐case knee surgery

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