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  • Title: Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation.
    Author: Cobo-Molinos J, Poncela-Garcia M, Marchal-Corrales JA, Delgado-Martinez AD.
    Journal: Eur J Anaesthesiol; 2014 Nov; 31(11):635-9. PubMed ID: 25000437.
    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.
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