Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis.
Shoulder arthroscopy has become a routine outpatient surgery. Pain control is a limiting factor for patient discharge after surgery, and several modalities are used to provide continued analgesia postoperatively. Regional anesthetic blocks and shoulder pain pumps are common methods to provide short-term pain control. Shoulder pain pumps can be used either in the subacromial space or within the glenohumeral joint. Several clinical studies suggested--which was confirmed by a bovine and rabbit cartilage study--that there is significant chondrotoxicity from bupivacaine, a local anesthetic commonly used in pain pumps. Postarthroscopic glenohumeral chondrolysis is a noninfectious entity associated with factors including use of radiofrequency thermal instruments and intra-articular pain pumps that administer bupivacaine, but there have been no cases reported with subacromial pain pump placement. Treatment options are difficult in a young patient with postarthroscopic glenohumeral chondrolysis, and understanding the literature with regard to risk factors is paramount to counseling patients and preventing this devastating complication.
Busfield
Benjamin T
BT
Arthritis, Orthopedic, and Sports Medical Center, Glendale, California 91206, USA. bbusfield@yahoo.com
Romero
Denise M
DM
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000818:Animals; D001182:Arthroscopy / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002357:Cartilage Diseases / Q000139:chemically induced*; D002358:Cartilage, Articular / Q000187:drug effects* / Q000473:pathology; D017115:Catheter Ablation / Q000009:adverse effects; D002417:Cattle; D019902:Chondrocytes / Q000187:drug effects / Q000473:pathology; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral; D007270:Injections, Intra-Articular; D017746:Joint Capsule / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy*; D011817:Rabbits; D017006:Rotator Cuff / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012785:Shoulder Joint / Q000187:drug effects* / Q000473:pathology; D055815:Young Adult
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D002045:Bupivacaine; D004837:Epinephrine