Bupivacaine Induces Short-Term Alterations and Impairment in Rat Tendons

Lehner, CE; Gehwolf, Renate; Hirzinger, Corinna; Stephan, Daniel; Augat, Peter; Tauber, Mark; Resch, Herbert; Bauer, Hans-Christian; Bauer, Hannelore; Tempfer, Herbert

doi:10.1177/0363546513485406

Cited by 22 publications

(34 citation statements)

References 40 publications

(49 reference statements)

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“…The same accounts for the use of anaesthetics as a control group, which was used in three studies (two in combination with corticosteroids). From a recent animal study, it is known that bupivacaine has detrimental effects on tendon cell viability, which may put the tendon at increased risk of overload or acute injury 31. This stresses the need for placebo-controlled studies in the field of treatments for tendinopathies 32.…”

Section: Discussionmentioning

confidence: 99%

Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review

2014

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BackgroundChronic lateral epicondylar tendinopathy is frequent in athletes, and platelet-rich plasma (PRP) is being used increasingly in its treatment.ObjectiveTo systematically review the literature on the efficacy of PRP injections for chronic lateral epicondylar tendinopathy.MethodsThe databases of PubMed, EMBASE, CINAHL, Medline OvidSP, Scopus, Google Scholar, Web of Science and Cochrane Library were searched in October 2013. Inclusion criteria were a clinical diagnosis of chronic lateral epicondylar tendinopathy, a randomised controlled trial, an intervention with a PRP injection and the outcome measures described in terms of pain and/or function. One author screened the search results and two authors independently assessed the study quality using the Physiotherapy Evidence Database (PEDro) score. A study was considered to be of high quality if its PEDro score was ≥6. A best evidence synthesis was used to identify the level of evidence.Results6 studies were included, of which four were considered to be of high quality. Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy.ConclusionsThere is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.

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Section: Discussionmentioning

confidence: 99%

Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review

2014

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“…However, in vitro studies have shown the toxicity of local anesthetics on tendon fibroblasts . Lehner et al reported that the treatment of rat tendon‐derived cells with 0.5% bupivacaine for 10 min had detrimental effects on cell viability . Piper et al showed a toxic effect of 30 min of 1% lidocaine treatment on bovine tendon fibroblasts .…”

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confidence: 99%

“…Despite the deleterious effects of the local anesthetics as evaluated by in vitro studies, lidocaine is frequently used preoperatively in clinical practice in rotator cuff tears; however, in vivo data on the effects of lidocaine are lacking. These results prompted us to examine how lidocaine acts on rotator cuff tears when used in subacromial injection for this disease.…”

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confidence: 99%

Effects of lidocaine on torn rotator cuff tendons

Honda

Gotoh

Kanazawa

et al. 2016

Journal Orthopaedic Research

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We determined lidocaine's action on torn rotator cuff tendons in vitro and in vivo. For in vitro experiments, cell proliferation and viability assays were performed using tenocytes derived from human torn rotator cuff tendons. For in vivo experiments, acute rotator cuff tears were made on the supraspinatus tendons in the rats' bilateral shoulders; before closure, lidocaine was injected into the shoulder and saline into the contralateral shoulder (control). After sacrifice, the specimens underwent biomechanical testing or histological analysis at 24 h and at 2, 4, and 8 weeks after surgery. The extent of collagen organization and apoptosis were semi-quantitatively evaluated using collagen picrosirius red staining. Apoptosis was examined using TUNEL staining and electron microscopy. Cell proliferation decreased dose-dependently. After exposure to 0.1% lidocaine for 24 h, cell viability decreased. Two and 4 weeks after surgery, the ultimate load to failure decreased more in the lidocaine group than in the control group, with significantly reduced stiffness in the lidocaine group 2 weeks after surgery. Collagen organization significantly decreased in the lidocaine group by 4 weeks after surgery but returned to baseline at 8 weeks. TUNEL staining detected numerous apoptotic tenocytes at the torn tendon edge exposed to lidocaine 24 h after surgery; electron microscopy confirmed the condensed cell nuclei. These changes were not observed in controls. Lidocaine caused cytotoxicity to tenocytes under both conditions, decreased biomechanical properties, and induced apoptosis and delay of collagen organization in this model. Subacromial lidocaine injections in patients with rotator cuff tears should be performed carefully. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1620-1627, 2016.

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“…However, both have come under recent criticism and are suggested to generate worse long-term clinical outcomes than conservative treatment alone. Lehner et al (2013) reported on the detrimental effects of bupivicaine on tendon tissue in animal studies, demonstrating that bupivicaine injection increased the tendon vulnerability to injury and overload stress [27]. The use of corticosteroid injections to treat various tendinopathies, while still commonplace in clinical practice, has been repeatedly challenged by authors [28].…”

Section: Control Groupsmentioning

confidence: 99%

Platelet-Rich Plasma Therapies in Lateral Epicondylitis: Are we Asking the Right Questions?

Mathavan¹

2014

Orthop Muscul Syst

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Bupivacaine Induces Short-Term Alterations and Impairment in Rat Tendons

Abstract: Local anesthetics cause short-term alterations in rat tendons, which, if occurring in humans to a similar extent, may be relevant regarding decreased biomechanical properties and increased vulnerability to tendon overload or injury.

Cited by 22 publications

References 40 publications

Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review

Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review

Effects of lidocaine on torn rotator cuff tendons

Platelet-Rich Plasma Therapies in Lateral Epicondylitis: Are we Asking the Right Questions?

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