Department of Anaesthesiology and Critical Care

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Browsing Department of Anaesthesiology and Critical Care by browse.metadata.advisor "Firfiray, L."

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    Intra-articular bupivacaine : a literature review including a pilot study investigating the safety of intra-articular bupivacaine to chondrocytes
    (2015-12) Van der Merwe, Willem Jacobus; Firfiray, L.; Coetzee, Andre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anesthesiology and Critical Care.
    ENGLISH ABSTRACT: Background: Today, intra-articular bupivacaine injections are common practice, with very good analgesic effects. This method of analgesia is utilized by general practitioners, orthopedic surgeons and anesthesiologists. Unfortunately, since 2004, more than 200 cases of chondrolysis were noted following intra-articular bupivacaine infusion. Numerous studies have investigated the safety of intra-articular bupivacaine. The aim of this thesis was to quantify the risk of chondrolysis with intra-articular bupivacaine and to guide medical practitioners in safe practice. Methods: A literature review was done of the most recently published original research, meta-analysis and review articles. Adverse outcomes were mostly associated with bupivacaine infusions, rather than with single intra-articular doses of bupivacaine. Limited data on the safety of a single dose of intra-articular bupivacaine was found. We conducted a pilot study to investigate the safety of a single dose of intra-articular bupivacaine. A paired, case-controlled, experiment was done using four merino sheep. The nul hypothesis was that a single dose of intra-articular bupivacaine did not cause chondrolysis when compared with a dose of intra-articular normal saline. Our results were added to the thesis to further quantify the risk. Results: Numerous in vitro and in vivo studies confirmed that bupivacaine is chondrotoxic. The chondrotoxic effect is time, dose and concentration dependent. Our pilot study revealed that single dose intra-articular bupivacaine may also be unsafe for chondrocytes. Conclusion: The administration of intra-articular bupivacaine is toxic to chondrocytes. The chondrotoxic effect of intra-articular bupivacaine is time, dose and concentration dependent. Infusions of intra-articular bupivacaine should be contra-indicated. From the limited data available on single dose intra-articular bupivacaine, it appears that it is also chondrotoxic. Magnesium, morphine and clonidine may be safer for intra-articular use, but this needs further investigation.