Effect of intra-articular injection of levobupivacaine on articular cartilage and synovium in rats

Erden, İsmail; Altınel, Seher; Saricaoglu, Fatma; Zeybek, Naciye Dilara; Akıncı, Seda Banu; Aşan, Esin; Aypar, Ülkü

doi:10.1007/s00101-012-2007-3

Cited by 17 publications

(14 citation statements)

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“…These findings suggest that intra-articular local anaesthetics, especially when used as infusion, may be related to increased risk of postartroscopic chondrolysis and early osteoarthritis [ 1 ]. Higher concentrations, low pH (< 5), infusion pump usage for longer lasting effect and the use of epinephrine, which decreases pH, are among the factors related to increased chondrotoxicity [ 1 , 10 ]. Dogan et al [ 18 ] also conducted an experimental study on rabbit knees and found that compared to saline in joint cartilage and the synovium, bupivacaine and neostigmine injection histopathologically caused an increase in inflammation, inflammatory cell infiltration, synovial hyperplasia, and hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

“…Dragoo et al [ 16 ] did not find any signs of increased chondrotoxicity following exposure of in vitro human chondrocytes to 0.25% bupivacaine and 0.5% ropivacaine. Although the analgesic efficacy of intra-articular levobupivacaine has been shown in several human studies, we could find only two histopathological studies evaluating the chondrotoxicity of levobupivacaine in the literature [ 10 , 20 ]. The design of these experimental animal studies, which were also conducted at our university, was very similar to our study and thus has the same limitations of not being directly applicable to human tissue.…”

Section: Discussionmentioning

confidence: 99%

“…In the histological sections of the knee joints, the surface of the cartilage, cartilage zones (tangential, intermediate, radial and calcified zone), the synovium and soft connective tissue beyond the synovium were evaluated by two histologists who were blinded to the joint treatment groups. The inflammatory changes were graded in four fields per section and four sections per animal according to a five-point scale, based on a similar study of Erden et al [ 10 ]. Grade 0- no inflammation Grade 1- minimal inflammation: mild congestion and oedema Grade 2- mild inflammation: erosion of joint surface, congestion and oedema, and small number of neutrophils Grade 3- moderate inflammation: neutrophils and macrophages, and synoviocyte hyperplasia Grade 4- severe inflammation: neutrophils and macrophages, synoviocyte hyperplasia, and fibrin exudation …”

Section: Methodsmentioning

confidence: 99%

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Procaine and saline have similar effects on articular cartilage and synovium in rat knee

et al. 2018

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BackgroundIntra-articular local anaesthetics are widely used for providing postoperative analgesia and decreasing the need for opioids. Procaine has proven positive effects in carpal tunnel syndrome and chondromalacia patella. However, the effect of procaine on articular cartilage has not yet been studied. The aim of this study was to evaluate the effects of intra-articular procaine injection on the articular cartilage and the synovium.MethodsTwenty adult Sprague-Dawley rats were enrolled in the study. After providing anaesthesia and aseptic conditions, 0.25 ml of 10% procaine was injected to the right knee joint, and 0.25 ml of normal saline (as control group) was injected to the left knee joint. Knee joint samples were obtained from four rats in each group after appropriate euthanasia on days 1, 2, 7, 14 and 21. The histological sections of the articular and periarticular regions and the synovium were evaluated by two histologists, and inflammatory changes were graded according to a five-point scale in a blinded manner. The apoptosis of chondrocytes was determined by the caspase-3 indirect immunoperoxidase method.ResultsThere were no significant differences in inflammation between procaine and saline groups at any of the time intervals. Slight inflammatory infiltration due to injection was seen in both groups on the 1st day. Haemorrhage was observed in both groups at days 1 and 2, and the difference between groups was not found to be significant. No significant difference was detected in the percentage of apoptotic chondrocytes between groups at any of the time intervals.ConclusionsInjection of procaine seems safe to use intra-articularly based on this in vivo study on rat knee cartilage. However, further studies investigating both the analgesic and histopathological effects of procaine on damaged articular cartilage and synovium models are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Procaine and saline have similar effects on articular cartilage and synovium in rat knee

et al. 2018

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Section: Methodsmentioning

confidence: 99%

Procaine and saline have similar effects on articular cartilage and synovium in rat knee

Yılbaş¹

2016

Preprint

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Background: Intra-articular local anaesthetics are widely used for providing postoperative analgesia and decreasing the need for opioids. Procaine has proven positive effects in carpal tunnel syndrome and chondromalacia patella. However, the effect of procaine on articular cartilage has not yet been studied. The aim of this study was to evaluate the effects of intra-articular procaine injection on the articular cartilage and the synovium. Methods: Twenty adult Sprague-Dawley rats were enrolled in the study. After providing anaesthesia and aseptic conditions, 0.25 ml of 10% procaine was injected to the right knee joint, and 0.25 ml of normal saline (as control group) was injected to the left knee joint. Knee joint samples were obtained from four rats in each group after appropriate euthanasia on days 1, 2, 7, 14 and 21. The histological sections of the articular and periarticular regions and the synovium were evaluated by two histologists, and inflammatory changes were graded according to a fivepoint scale in a blinded manner. The apoptosis of chondrocytes was determined by the caspase-3 indirect immunoperoxidase method. Results: There were no significant differences in inflammation between procaine and saline groups at any of the time intervals. Slight inflammatory infiltration due to injection was seen in both groups on the 1st day. Haemorrhage was observed in both groups at days 1 and 2, and the difference between groups was not found to be significant. No significant difference was detected in the percentage of apoptotic chondrocytes between groups at any of the time intervals. Conclusions: Injection of procaine seems safe to use intra-articularly based on this in vivo study on rat knee cartilage. However, further studies investigating both the analgesic and histopathological effects of procaine on damaged articular cartilage and synovium models are needed.

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“…For example, rats can breathe 50% carbon dioxide without problems [41] while humans quickly become unconscious and develop seizures while breathing 10% carbon dioxide [38] indicating significant differences in cardiorespiratory physiology and hence, extrapolation difficulties between rodents and humans. In our experience, rodents are frequently used in basic science research laboratories [9] while swine are more favored in translational research [27].…”

Section: Introductionmentioning

confidence: 99%

Anesthesia in swine

et al. 2014

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In order to extrapolate novel therapies from the bench to the bedside (translational research), animal experiments are scientifically necessary. Swine are popular laboratory animals as their cardiorespiratory physiology is very similar to humans. Every study has to be approved by the local and/or national animal ethical committees. As swine are extremely sensitive to stress the primary goal is therefore to provide a calm, stress-free environment in both housing and experimental facilities. Swine should be properly sedated for transport and normothermia needs to be ensured. It is recommended to commence anesthesia by injecting ketamine and propofol followed by endotracheal intubation during spontaneous breathing. After intubation, anesthesia maintenance is performed with morphine or piritramide, propofol and rocuronium and routine monitoring is applied analogue to a clinical operating theater for humans. Normothermia (38.5 °C) needs to be ensured. While surgical procedures can be readily extrapolated from a human operating theater to swine, non-anesthesiologist scientists may lose the animal rapidly due to airway management problems. Vascular access can be secured by cut-downs or ultrasound-guided techniques in the inguinal and the neck region. For humane euthanasia of pigs, morphine, followed by propofol, rocuronium and potassium chloride are recommended. As radical animal right groups may threaten scientists, it is prudent that animal laboratories have unmarked entrance doors, are located in buildings that are not accessible to the public and strictly controlled access of laboratory staff is enforced. In conclusion, swine are an excellent laboratory animal for bench to bedside research and can be managed properly when basic knowledge and adequate skills on careful handling, anesthesia and surgical considerations are present.

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Effect of intra-articular injection of levobupivacaine on articular cartilage and synovium in rats

Abstract: 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.

Cited by 17 publications

References 16 publications

Procaine and saline have similar effects on articular cartilage and synovium in rat knee

Procaine and saline have similar effects on articular cartilage and synovium in rat knee

Procaine and saline have similar effects on articular cartilage and synovium in rat knee

Anesthesia in swine

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