Local Anesthetics’ Toxicity toward Human Cultured Chondrocytes: A Comparative Study between Lidocaine, Bupivacaine, and Ropivacaine

Abstract

Objective In orthopedic joint injection, the most frequently used local anesthetics are ropivacaine, bupivacaine, and 1% or 2% lidocaine. The aim of this study was to examine effects of these various anesthetics on the viability of human chondrocytes. Our hypothesis was that all local anesthetics tested damage human chondrocytes in vitro. Methods Primary human chondrocytes were isolated and cultured from 6 donated human knee joints (mean age of donors 61.2 years). Local anesthetics were added to these cultures. Toxicity analysis was performed by visualization of cell structure using light microscopy. Determination of vital chondrocytes was performed by use of a Casy cell counter. Chondrocytes' cell death was examined by fluorescence microscopy and an XTT ELISA assay. Results Light microscope and fluorescence microscope data revealed a defect cell structure and increased number of dead cells after addition of 1% or 2% lidocaine and bupivacaine but not ropivacaine. We were able to show an increased level of XTT activity after treatment with bupivacaine, 2% lidocaine or ropivacaine. The count of vital chondrocytes was significantly decreased after treatment with bupivacaine, 1% or 2% lidocaine, and ropivacaine. Conclusions The data show that treatment with local anesthetics induces cell damage of human chondrocytes in vitro. Ropivacaine seems to be a local anesthetic with the lowest toxic potential on human chondrocytes, a feature that may favor its preference for use in joint injection.

Protective effects of platelet-rich plasma against lidocaine cytotoxicity on canine articular chondrocytes

“…Our results are in accordance with Durant et al that shows the protective effect of PRP against 1% and 0.5% LD bupivacaine on human chondrocytes [ 26 ]. Moreover, our results demonstrate that PRP is also able to protect chondrocytes at the concentration of 1.8% which is close to the maximum recommended in vivo dose (2%) [ 27 ], and shows that PRP may reduce LD-induced apoptosis. Baboldashti et al [ 25 ] previously demonstrated that PRP protects tenocytes from the adverse effects of dexamethasone and ciprofloxacin, and proposed using PRP to minimize the effect of unsafe therapeutic treatments.…”

“…Dilutions of LD and PRP were prepared in DPBS. Although the most commonly administered doses of LD are 1% and 2% [ 27 ] we used 1.8% instead 2% in order to obtain 10% of PRP in association with LD, as the highest commercially available concentration of LD is at 2%.…”

Dexmedetomidine Addition For Pediatric Hernia Repair: A Meta-Analysis of Randomized Controlled Studies

“…Local anesthetics such as bupivacaine and ropivacaine were used for peripheral nerve block, sympathetic nerve block, local in ltration, epidural and caudal blocks [11,[26][27][28]. Combination dexmedetomidine with bupivacaine or ropivacaine can prolong the analgesic effect [14,29,30].…”

Top-Ten Tips for Ultrasound-Guided Joint Injection

“…24 Ropivacaine 0.1 to 0.2% is considered the safest local anesthetic to use regarding chondral toxicity, but low-dose bupivacaine (0.0625%) is also acceptable and several times less expensive than ropivacaine. 24,25 Nevertheless, it would still seem reasonable to inject a local anesthetic agent into end-stage osteoarthritic joints with little or no remaining cartilage for symptomatic relief before joint replacement or to relieve some of the discomfort that may accompany steroid injection (steroid flare).…”