Improved Chondrotoxic Profile of Liposomal Bupivacaine Compared With Standard Bupivacaine After Intra-articular Infiltration in a Porcine Model

K. Aaron Shaw, Colleen Moreland, Jeremy Jacobs, Justin M. Hire, Richard L Topolski, Nathan Hoyt, Stephen Arthur Parada, Craig D. Cameron

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Increasingly, liposomal bupivacaine is being used with multimodal pain management strategies. In vitro investigations have shown decreased chondrotoxicity profiles for liposomal bupivacaine; however, there is no evidence regarding its in vivo effects. Hypothesis/Purpose: This study sought to investigate the in vivo chondrotoxicity of liposomal bupivacaine, hypothesizing that there would be increased chondrocyte viability after exposure to liposomal bupivacaine when compared with standard bupivacaine. Study Design: Controlled laboratory study. Methods: Eight juvenile, female Yorkshire cross piglets underwent a lateral stifle joint injection with either 1.3% liposomal bupivacaine or 0.5% bupivacaine. Injections were performed on one joint per animal with no injection to the contralateral knee, which served as the control. Chondrocyte viability was assessed 1 week after injection with a live-dead staining protocol and histologic examination. Results: Significant chondrocyte death was seen with the live-dead staining in the bupivacaine group (33% nonviable cells) in comparison with liposomal bupivacaine (6.2%) and control (5.8%) groups (P <.01). However, histologic examination showed no differences in chondral surface integrity, fibrillation, and chondrocyte viability. Conclusion: Liposomal bupivacaine was found to be safe for intra-articular injection in this animal model. Although bupivacaine demonstrated decreased chondrocyte viability on a cellular level, histologically there were no changes. This study highlights the dichotomy between fluorescent staining and histologic appearance of articular chondrocytes in short-term analyses of viability. Clinical Relevance: This study supports the peri-articular application of liposomal bupivacaine in the setting of preserved articular cartilage. A single injection of standard bupivacaine did not produce histologic changes in the articular cartilage.

Original languageEnglish (US)
Pages (from-to)66-71
Number of pages6
JournalAmerican Journal of Sports Medicine
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Bupivacaine
Swine
Joints
Chondrocytes
Injections
Articular Cartilage
Staining and Labeling
Stifle
Intra-Articular Injections
Pain Management
Cartilage
Knee
Animal Models

Keywords

  • bupivacaine
  • chondrotoxicity
  • intra-articular injections
  • liposomal bupivacaine
  • porcine model

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Improved Chondrotoxic Profile of Liposomal Bupivacaine Compared With Standard Bupivacaine After Intra-articular Infiltration in a Porcine Model. / Shaw, K. Aaron; Moreland, Colleen; Jacobs, Jeremy; Hire, Justin M.; Topolski, Richard L; Hoyt, Nathan; Parada, Stephen Arthur; Cameron, Craig D.

In: American Journal of Sports Medicine, Vol. 46, No. 1, 01.01.2018, p. 66-71.

Research output: Contribution to journalArticle

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abstract = "Background: Increasingly, liposomal bupivacaine is being used with multimodal pain management strategies. In vitro investigations have shown decreased chondrotoxicity profiles for liposomal bupivacaine; however, there is no evidence regarding its in vivo effects. Hypothesis/Purpose: This study sought to investigate the in vivo chondrotoxicity of liposomal bupivacaine, hypothesizing that there would be increased chondrocyte viability after exposure to liposomal bupivacaine when compared with standard bupivacaine. Study Design: Controlled laboratory study. Methods: Eight juvenile, female Yorkshire cross piglets underwent a lateral stifle joint injection with either 1.3{\%} liposomal bupivacaine or 0.5{\%} bupivacaine. Injections were performed on one joint per animal with no injection to the contralateral knee, which served as the control. Chondrocyte viability was assessed 1 week after injection with a live-dead staining protocol and histologic examination. Results: Significant chondrocyte death was seen with the live-dead staining in the bupivacaine group (33{\%} nonviable cells) in comparison with liposomal bupivacaine (6.2{\%}) and control (5.8{\%}) groups (P <.01). However, histologic examination showed no differences in chondral surface integrity, fibrillation, and chondrocyte viability. Conclusion: Liposomal bupivacaine was found to be safe for intra-articular injection in this animal model. Although bupivacaine demonstrated decreased chondrocyte viability on a cellular level, histologically there were no changes. This study highlights the dichotomy between fluorescent staining and histologic appearance of articular chondrocytes in short-term analyses of viability. Clinical Relevance: This study supports the peri-articular application of liposomal bupivacaine in the setting of preserved articular cartilage. A single injection of standard bupivacaine did not produce histologic changes in the articular cartilage.",
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AU - Jacobs, Jeremy

AU - Hire, Justin M.

AU - Topolski, Richard L

AU - Hoyt, Nathan

AU - Parada, Stephen Arthur

AU - Cameron, Craig D.

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AB - Background: Increasingly, liposomal bupivacaine is being used with multimodal pain management strategies. In vitro investigations have shown decreased chondrotoxicity profiles for liposomal bupivacaine; however, there is no evidence regarding its in vivo effects. Hypothesis/Purpose: This study sought to investigate the in vivo chondrotoxicity of liposomal bupivacaine, hypothesizing that there would be increased chondrocyte viability after exposure to liposomal bupivacaine when compared with standard bupivacaine. Study Design: Controlled laboratory study. Methods: Eight juvenile, female Yorkshire cross piglets underwent a lateral stifle joint injection with either 1.3% liposomal bupivacaine or 0.5% bupivacaine. Injections were performed on one joint per animal with no injection to the contralateral knee, which served as the control. Chondrocyte viability was assessed 1 week after injection with a live-dead staining protocol and histologic examination. Results: Significant chondrocyte death was seen with the live-dead staining in the bupivacaine group (33% nonviable cells) in comparison with liposomal bupivacaine (6.2%) and control (5.8%) groups (P <.01). However, histologic examination showed no differences in chondral surface integrity, fibrillation, and chondrocyte viability. Conclusion: Liposomal bupivacaine was found to be safe for intra-articular injection in this animal model. Although bupivacaine demonstrated decreased chondrocyte viability on a cellular level, histologically there were no changes. This study highlights the dichotomy between fluorescent staining and histologic appearance of articular chondrocytes in short-term analyses of viability. Clinical Relevance: This study supports the peri-articular application of liposomal bupivacaine in the setting of preserved articular cartilage. A single injection of standard bupivacaine did not produce histologic changes in the articular cartilage.

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