Dr. Erika Kancler
Objectives: Intraarticular injections of corticosteroids used in combination with local anesthetics are commonly used in orthopedic practice for osteoarthritic pain relief. Many orthopedists question whether these anesthetics have chondrotoxic effects on human articular cartilage. The purpose of this meta- analysis is to examine the chondrotoxic effects of local anesthetics on osteoarthritic human articular cartilage and to determine whether ropivacaine has fewer chondrotoxic effects than bupivacaine.
Methods: Studies were found using PubMed with the search terms, “Ropivacaine,” “Bupivacaine,” and “Chondrocytes.” Initially 20 studies were found. Several studies were eliminated using the following excluding factors: human studies, published in last 10 years, English language and inclusion of ropivacaine and bupivacaine. The final studies were chosen based on their relation to our clinical question.
Results: Studies show that concentrations less than 0.75% ropivacaine and concentrations of 0.25% bupivacaine or less have fewer chondrotoxic effects on osteoarthritic cartilage. Studies show that chondrotoxicity increases with time after exposure and increases from ropivacaine to bupivacaine.
Conclusion: Both ropivacaine and bupivacaine are chondrotoxic to human cartilage in a time-dependent, drug-dependent, and concentration-dependent manner. Future studies are needed to observe results for longer durations and investigate whether chondrotoxicity is potency-dependent in order to conclude that ropivacaine is a safer option than bupivacaine.
Burke SA, Price LM. Bupivacaine vs. Ropivacaine: Looking at the chondrotoxic effects of intraarticular anesthetics in osteoarthritic joints. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/24. Published May 16, 2017.