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June 2010, Volume 40 Number 6 , p 18 - 19


  • Joan Ferlo Todd MS, BSN, RN


AFTER LEFT SHOULDER arthroscopy, an elastomeric infusion device was used to deliver a continuous infusion (over about 48 hours) of the local anesthetic bupivacaine directly into the patient's intra-articular space for postoperative pain control. Approximately 5 months following the infusion, the patient developed pain, stiffness, and loss of motion in the left glenohumeral (shoulder) joint.Postarthroscopic glenohumeral chondrolysis (PAGCL), which is necrosis and destruction of articular cartilage, was subsequently diagnosed. The patient required a total shoulder arthroplasty, according to a report sent to the FDA.The FDA has received approximately 35 reports of chondrolysis in patients who received continuous intra-articular infusions of local anesthetics with elastomeric infusion devices (often called pain pumps) for postoperative pain management. (See A closer look at elastomeric infusion devices.) The local anesthetics involved include bupivacaine, chloroprocaine, lidocaine, mepivacaine, procaine, and ropivacaine with and without epinephrine. Chondrolysis, a severe, life-altering complication, is usually irreversible. (For more details, see What's chondrolysis?)It isn't known what factor or combination of factors contributed to the development of chondrolysis in these cases. The infused local anesthetic drug, the device materials, or other sources may have contributed.Before 2000, the reported incidence of chondrolysis was low. Reports of PAGCL began to appear more frequently as surgeons began to use newer devices, such as lasers and thermal devices, and newer techniques, including intra-articular injection of dye and continuous postoperative infusion of anesthetics into the glenohumeral joint.1-3In general, elastomeric infusion devices are safe when used properly. The FDA has approved them for the perioperative and postoperative infusion of local anesthetics and opioids for pain management and regional anesthesia via the I.V., I.M., subcutaneous, perineural,

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