title: Published evidence demonstrating the causation of glenohumeral chondrolysis by postoperative infusion of local anesthetic via a pain pump.
abstract: BACKGROUND
  Glenohumeral chondrolysis is the irreversible destruction of previously normal articular cartilage, occurring most commonly after shoulder surgery in young individuals. The reported incidence of this complication has risen rapidly since the early 2000s. As chondrolysis cannot be reversed, its occurrence can only be prevented by establishing and avoiding its causes.
  
  
  METHODS
  We analyzed all published cases of glenohumeral chondrolysis, including the relevant published laboratory data, to consolidate the available evidence on the causation of this complication by the postoperative intra-articular infusion of local anesthetic via a pain pump.
  
  
  RESULTS
  Analysis of the published evidence demonstrated a causal relationship between the infusion of local anesthetic and the development of glenohumeral chondrolysis. The risk of this complication in shoulders receiving intra-articular infusions via a pain pump was significantly greater with higher doses of local anesthetic: twenty of forty-eight shoulders receiving high-flow infusions developed chondrolysis, whereas only two of twenty-five shoulders receiving low-flow infusions developed this complication (p = 0.0029). Eleven of twenty-two shoulders receiving 0.5% bupivacaine developed chondrolysis, whereas none of six shoulders receiving 0.25% bupivacaine developed this complication (p = 0.05). Of twenty-two shoulders infused with 0.5% bupivacaine, the eleven that developed chondrolysis had a mean pain pump delivery volume of 377 mL, whereas the eleven that did not develop chondrolysis had a mean volume of 187 mL (p = 0.003). Among shoulders in which an intra-articular pain pump was used, the risk of chondrolysis was significantly greater when suture anchors were placed in the glenoid for labral repair (p < 0.001).
  
  
  CONCLUSIONS
  The published evidence indicates that the preponderance of cases of glenohumeral chondrolysis can be prevented by the avoidance of the intra-articular infusion of local anesthetic via a pain pump.
authors.affiliation: Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA 98195, USA. matsen@u.washington.edu
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Matsen
authors.forename: Anastasios
authors.initials: A
authors.lastname: Papadonikolakis
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002357:Cartilage Diseases / Q000139:chemically induced*; D002358:Cartilage, Articular; D006801:Humans; D007260:Infusion Pumps; D036502:Infusions, Intralesional; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care / Q000009:adverse effects / Q000295:instrumentation; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000517:prevention & control
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine