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局部麻醉药和皮质类固醇对软骨细胞和滑膜细胞活力和代谢的体内毒性。

In Vivo Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte Viability and Metabolism.

机构信息

Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.

Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO, USA.

出版信息

Cartilage. 2015 Apr;6(2):106-12. doi: 10.1177/1947603515571001.


DOI:10.1177/1947603515571001
PMID:26069713
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4462250/
Abstract

OBJECTIVE: Intra-articular injection of local anesthetic and/or corticosteroid is an adjunct treatment for arthritic and inflammatory orthopedic conditions. Despite potential benefits, there is growing concern that these medications may cause significant morbidity, including potential toxicity to intra-articular chondrocytes and synoviocytes. DESIGN: Twenty dogs underwent intra-articular injection of the shoulder joint using ultrasound guidance, with the following injectates (n = 5 each): negative control (saline), methylprednisolone/1.0% lidocaine, triamcinolone/1.0% lidocaine, and triamcinolone/0.0625% bupivacaine. The dogs were euthanized 24 hours postinjection for reasons unrelated to this study. Synovium/cartilage explants were harvested under sterile conditions and assessed immediately or cultured for 7 days. Synoviocyte and chondrocyte viability was determined on day 1 and day 7 using Calcien AM and Sytox Blue live/dead fluorescent stains, and cell metabolism determined on day 2 using the alamar blue additive test. Results were compared statistically. RESULTS: On day 1 synovium exposed to 1%L/M demonstrated a significant decrease in cell metabolism (P = 0.0107) and subjective synoviocyte viability scores (P = 0.013) compared with the negative control. Cartilage exposed to 1%L/M demonstrated decreased chondrocyte viability and cell metabolism versus all other groups, although not significantly. After 7 days of culture, cartilage viable cell density in the 1%L/M group was significantly (P ≤ 0.001) lower than the negative control. Subjective synoviocyte viability scores was significantly lower in the 1%L/M (P = 0.013), 1%L/T (P ≤ 0.001), and 0.0625%B/T groups (P = 0.006) compared with the negative control. CONCLUSIONS: This study suggests potential negative effects of combination local anesthetic/corticosteroid on intra-articular cell viability and cell metabolism. Further study is needed before determining definitive clinical recommendations.

摘要

目的:关节内注射局部麻醉药和/或皮质类固醇是治疗关节炎和炎症性骨科疾病的辅助治疗方法。尽管有潜在的益处,但人们越来越担心这些药物可能会引起显著的发病率,包括对关节内软骨细胞和滑膜细胞的潜在毒性。

设计:20 只狗接受了超声引导下的肩关节关节内注射,以下列注射剂(每组 5 只):阴性对照(生理盐水)、甲泼尼龙/1.0%利多卡因、曲安奈德/1.0%利多卡因和曲安奈德/0.0625%布比卡因。狗在注射后 24 小时因与本研究无关的原因被安乐死。在无菌条件下采集滑膜/软骨标本,并立即或培养 7 天进行评估。在第 1 天和第 7 天使用 Calcien AM 和 Sytox Blue 活/死荧光染色测定滑膜细胞和软骨细胞活力,在第 2 天使用 alamar blue 添加剂试验测定细胞代谢。结果进行统计学比较。

结果:在第 1 天,与阴性对照组相比,暴露于 1%L/M 的滑膜显示细胞代谢显著降低(P = 0.0107)和主观滑膜细胞活力评分降低(P = 0.013)。暴露于 1%L/M 的软骨显示与所有其他组相比,软骨细胞活力和细胞代谢降低,尽管没有显著差异。培养 7 天后,1%L/M 组软骨活细胞密度显著低于阴性对照组(P ≤ 0.001)。1%L/M(P = 0.013)、1%L/T(P ≤ 0.001)和 0.0625%B/T 组的主观滑膜细胞活力评分均显著低于阴性对照组(P = 0.006)。

结论:本研究提示联合局部麻醉药/皮质类固醇对关节内细胞活力和细胞代谢可能有潜在的不良影响。在确定明确的临床建议之前,需要进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/27b8d6e84bd0/10.1177_1947603515571001-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/debb3f33a0d6/10.1177_1947603515571001-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/91909091bae5/10.1177_1947603515571001-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/b87bb2b24f82/10.1177_1947603515571001-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/0b93f6f118b0/10.1177_1947603515571001-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/5f5caa57191d/10.1177_1947603515571001-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/27b8d6e84bd0/10.1177_1947603515571001-fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/debb3f33a0d6/10.1177_1947603515571001-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/91909091bae5/10.1177_1947603515571001-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/b87bb2b24f82/10.1177_1947603515571001-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/0b93f6f118b0/10.1177_1947603515571001-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/5f5caa57191d/10.1177_1947603515571001-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/63c9/4462250/27b8d6e84bd0/10.1177_1947603515571001-fig6.jpg

相似文献

[1]
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Cartilage. 2015-4

[2]
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[6]
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[7]
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[5]
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[6]
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[7]
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[8]
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[9]
Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature.

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[10]
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本文引用的文献

[1]
The in vitro chondrotoxicity of single-dose local anesthetics.

Am J Sports Med. 2012-1-27

[2]
Effects of local anesthetics on articular cartilage.

Am J Sports Med. 2011-4-22

[3]
Bupivacaine and triamcinolone may be toxic to human chondrocytes: a pilot study.

Clin Orthop Relat Res. 2011-3-8

[4]
Human chondrocyte viability after treatment with local anesthetic and/or magnesium: results from an in vitro study.

Arthroscopy. 2010-10-16

[5]
Increased chondrocyte death after steroid and local anesthetic combination.

Clin Orthop Relat Res. 2010-8-11

[6]
Chondrotoxicity of low pH, epinephrine, and preservatives found in local anesthetics containing epinephrine.

Am J Sports Med. 2010-3-26

[7]
Is chemical incompatibility responsible for chondrocyte death induced by local anesthetics?

Am J Sports Med. 2010-3

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Apoptosis and mitochondrial dysfunction in human chondrocytes following exposure to lidocaine, bupivacaine, and ropivacaine.

J Bone Joint Surg Am. 2010-3

[9]
In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage.

J Bone Joint Surg Am. 2010-3

[10]
The effect of bupivacaine and morphine in a coculture model of diarthrodial joints.

Arthroscopy. 2009-3

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