Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation

Eur J Anaesthesiol. 2014 Nov;31(11):635-9. doi: 10.1097/EJA.0000000000000115.

Abstract

Background: Intra-articular injection of local anaesthetics is a technique commonly used to enhance postoperative analgesia following arthroscopic surgery. However, the potential for cartilage damage due to toxicity of intra-articular local anaesthetics is a concern. Most studies indicate that the toxic effect is drug and time dependent.

Objectives: The objective of this study is to compare the in-vitro chondrotoxic effect of levobupivacaine on human cartilage with saline and bupivacaine.

Design: An experimental study.

Setting: University hospital.

Participants: Adult patients undergoing knee surgery.

Interventions: Human articular cartilage was harvested and removed from five patients during knee replacement surgery. Chondrocytes were cultured and divided into three groups exposed to bupivacaine 0.5%, levobupivacaine 0.5% or physiological saline for 15, 30 or 60 min.

Main outcome measures: Viability of human cartilage cells after contact with the different study drugs at different durations of exposure using two techniques: live/dead cell viability flow cytometry analysis and trypan blue exclusion assay.

Results: At 1 h of exposure, chondrocyte mortality in cartilage explants was significantly greater after treatment with levobupivacaine or bupivacaine than with saline (25.9% ± 14.1, 20.7% ± 10.4 and 9.6% ± 5.4, respectively). No differences between groups were found when exposure to the experimental drug was limited to 15 or 30 min.

Conclusion: In-vitro 0.5% levobupivacaine is more chondrotoxic than saline in human articular cartilage after 1 h of exposure. Bupivacaine seems to be less chondrotoxic than levobupivacaine. With shorter exposures, no clear chondrotoxic effect was shown.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthetics, Local / pharmacology*
  • Anesthetics, Local / toxicity
  • Bupivacaine / analogs & derivatives*
  • Bupivacaine / pharmacology
  • Bupivacaine / toxicity
  • Cartilage, Articular / drug effects*
  • Cartilage, Articular / physiology
  • Cell Death / drug effects
  • Cell Death / physiology
  • Cell Survival / drug effects
  • Cell Survival / physiology
  • Chondrocytes / drug effects*
  • Chondrocytes / physiology
  • Flow Cytometry / methods
  • Humans
  • Injections, Intra-Articular
  • Levobupivacaine

Substances

  • Anesthetics, Local
  • Levobupivacaine
  • Bupivacaine