Post-Operative Pain Pump Use in Knees Discouraged
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A new study published in The Journal of Bone & Joint Surgery discourages surgeons from using post-operative pain pumps undergoing knee surgery, concluding that there are equally effective ways to manage post-operative pain that would not subject patients to such significant potential harm. The authors of the study from Wansbeck General Hospital in Ashington, England concluded that surgeons could avoid the “possible chondrotoxic insult” to knee cartilage by utilizing local anesthetics around the portals rather than “intra-articular infiltration.”
Use of post-operative pain pumps, such as those marketed by Breg, Stryker, I-Flow, and Don-Joy, have come under great scrutiny lately as a number of patients have developed chondrolysis or destruction of their cartilage after the pain pump catheters were placed into the joint spaces of patients and then bathed in local anesthetics such as bupivacaine and marcaine. Lawsuits against the manufacturers of the pain pumps and the anesthetic drugs are pending in state and federal courts across the nation. The stories of these plaintiffs are quite compelling, as many are very young, health patients who underwent surgery to correct minor sports-related injuries and are now facing a lifelong series of joint replacement surgeries and disability.
The authors of this study noted:
Intra-articular bupivacaine is widely used as a local anesthestic in arthroscopic surgery, either as a single agent or to supplement regional or general anesthesia. A growing number of laboratory studies have demonstrated the potential toxicity of bupivacaine to articular cartilage. Most recently, Chu et al demonstrated that exposure of human chondrocytes in vitro to 0.5% bupivacaine for just 15 minutes resulted in cell viability of only 41%. Gomoll et al examined a rabbit shoulder in vivo and showed significant histopathological and metabolic changes in articular cartilage following continuous intra-articular infusion of bupivacaine. Recent reports have also implicated the use of bupivacaine in post-operative chondrolysis in the human glenohumeral and ankle joints.
This latest study adds further evidence to the mounting pile of studies, case reports, animal data, and adverse event reports documenting widespread development of chondrolysis in young, otherwise healthy patients who utilized a post-operative pain pump with delivery of anesthetic drugs directly into their joint space after surgery. The Food & Drug Administration is currently investigating these reports as well, and at least some of the manufacturers are now, for the first time, warning surgeons that intra-articular placement of the pain pump catheter may present a risk to patients.