Abstract
Objective
Intra-articular local anesthetics are often used for prevention of pain after arthroscopic knee surgery. However, the effect of local anesthetics other than bupivacaine on articular cartilage and synovium has not been studied. Also, complications associated with the injection of intra-articular bupivacaine have appeared in the literature. The aim of this study was to evaluate the effects of levobupivacaine on the articular cartilage and the synovium in rats.
Methods
Under aseptic conditions 0.25 ml (5 mg/ml) of levobupivacaine was injected into the right knee joint while 0.25 ml of saline was simultaneously injected into the left knee joint of 20 adult Sprague-Dawley rats. The purpose of saline injections was to serve as a control group. Groups of five rats were killed on days 1, 7, 14 and 21 after administration of injections. The knee joint samples were evaluated for the presence of inflammation in the articular and periarticular tissues and the synovium.
Results
There were no significant differences between the levobupivacaine and control groups with respect to inflammation in the articular and periarticular tissues and the synovium.
Conclusions
Although more studies are needed before final recommendations can be made, by evaluating the results obtained from this study, the clinical use of intra-articular levobupivacaine can be recommended for arthroscopic knee surgery.
Zusammenfassung
Ziel der Studie
Nach arthroskopischen Eingriffen am Knie werden zur Schmerzprophylaxe häufig intraartikulär Lokalanästhetika appliziert. Doch bisher wurde − mit Ausnahme von Bupivacain − kein Lokalanästhetikum hinsichtlich seiner Wirkungen auf Gelenkknorpel und Synovia untersucht. Zudem sind mit der intraartikulären Bupivacaininjektion vergesellschaftete Komplikationen beschrieben. Ziel der Studie war die tierexperimentelle Evaluierung der Effekte von Levobupivacain auf Gelenkknorpel und Synovia.
Methoden
Unter aseptischen Bedingungen wurden gleichzeitig 0,25 ml (5 mg/ml) Levobupivacain in das rechte Kniegelenk und 0,25 ml Natriumchloridlösung (Kontrolle) in das linke Kniegelenk injiziert. Verwendet wurden 20 ausgewachsene Sprague-Dawley-Ratten. Jeweils 5 Ratten wurden an den Tagen 1, 7, 14 und 21 nach den Injektionen getötet. Die Kniegelenkbiopsien wurden histologisch auf Entzündungszeichen in der Synovia sowie im intra- und periartikulären Gewebe untersucht.
Ergebnisse
Hinsichtlich der Entzündung im artikulären und periartikulären Gewebe sowie in der Synovia bestanden keine signifikanten Unterschiede zwischen der Levobupivacain- und der Kontrollgruppe.
Fazit
Für definitive Empfehlungen sind zwar noch weitere Studien erforderlich, doch aufgrund der hier vorgestellten Ergebnisse lässt sich schon jetzt zu einer intraartikulären Gabe von Levobupivacain nach arthroskopischen Eingriffen am Knie raten.
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Erden, I., Altinel, S., Saricaoglu, F. et al. Effect of intra-articular injection of levobupivacaine on articular cartilage and synovium in rats. Anaesthesist 61, 420–423 (2012). https://doi.org/10.1007/s00101-012-2007-3
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DOI: https://doi.org/10.1007/s00101-012-2007-3
Keywords
- Injections, intra-articular
- Levobupivacaine
- Anesthetics, adverse effects
- Rats, Sprague-Dawley
- Knee joint surgery