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Opioids as an alternative to amide-type local anaesthetics for intra-articular application

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Recently, the safety profile of local anaesthetics in intra-articular use became into focus of investigation. Opioid drugs have a different mode of action and may be a safe and potent alternative for intra-articular application. The purpose of this in vitro study is to provide evidence for significant chondrotoxicity of amide-type local anaesthetics even after short-term application on human chondrocytes and to demonstrate the absence of such negative effects for opioids [morphine, morphine-6-glucuronide (M6G)].

Method

Visually intact cartilage explants of human, mainly osteoarthritic joints (n = 9), were harvested and cultivated in monolayer for expansion and transferred into alginate bead. The beads were incubated for increasing incubation times (15 min, 1 and 4 h) in decreasing concentrations (full, ½, ¼ for 15 min) of bupivacaine, ropivacaine, morphine, M6G or saline control. Adenosine triphosphate content of 798 beads was measured 3 days post-incubation to assess cell viability.

Results

A clear ranking of cytotoxic potency: bupivacaine > ropivacaine > morphine = M6G = saline was observed. Results reveal a dose- and time-dependent manner of cytotoxic effects on human chondrocytes for bupivacaine and ropivacaine but not for opioids. Cell viability after exposure to morphine and M6G was comparable to exposure to saline.

Conclusion

The results confirm dose- and time-dependent cytotoxic effects on human chondrocytes for amide-type local anaesthetics. This study confirms the safety of morphine and M6G in terms of an absence of cytotoxic effects after intra-articular application, making them safe potential alternatives in clinical practice.

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Acknowledgments

The present study was financed by a research grant to the Orthopedic Department of the University from the Research Commission of the Medical Faculty University Düsseldorf, Germany.

Conflict of interest

None of the authors have any financial and personal relationships with other people or organizations that could potentially and inappropriately influence (bias) the present manuscript and conclusions.

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Authors and Affiliations

  1. Department of Orthopedics, University Hospital, Heinrich-Heine-University, Duesseldorf, Germany

    Irina Ickert, Melanie Vogl, Christoph Ziskoven, Christoph Zilkens, Rüdiger Krauspe & Jörn Kircher

  2. Department of Vascular and Endovascular Surgery, University Hospital, Albert-Schweitzer-Campus 1, Building W30, 48149, Münster, Germany

    Monika Herten

Authors
  1. Irina Ickert
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  2. Monika Herten
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  3. Melanie Vogl
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  4. Christoph Ziskoven
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  6. Rüdiger Krauspe
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  7. Jörn Kircher
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Correspondence to Monika Herten.

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Ickert, I., Herten, M., Vogl, M. et al. Opioids as an alternative to amide-type local anaesthetics for intra-articular application. Knee Surg Sports Traumatol Arthrosc 23, 2674–2681 (2015). https://doi.org/10.1007/s00167-014-2989-2

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  • DOI: https://doi.org/10.1007/s00167-014-2989-2

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