Jayaram Prathap, Kennedy David J, Yeh Peter, Dragoo Jason
H. Ben Dept. Physical Medicine & Rehabilitation, Dept of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX.
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
PM R. 2019 Apr;11(4):379-400. doi: 10.1002/pmrj.12007. Epub 2019 Mar 15.
To review the current literature on the effects of intraarticular local anesthetics on human knee articular cartilage.
PubMed; MEDLINE; SCOPUS; PEDro; CINAHL databases (1/1990-06/1/2018) were searched for local anesthetic effects on human knee articular cartilage.
Sixteen studies met the inclusion criteria, with outcome measures assessing chondrocyte viability, morphology, and histology. A systematic review was performed using PRISMA guidelines.
Seven studies were identified evaluating lidocaine, with five of them demonstrating statistically significant chondrotoxic effects. Fourteen studies examined bupivacaine, with all but one study demonstrating a chondrotoxic effect. Eight studies examined ropivacaine and found a dose-dependent chondrotoxicity starting at 0.75%. Two studies evaluated levobupivacaine showing chondrotoxicity, with one study showing it to be more chondrotoxic than bupivacaine. One study looked at mepivacaine and showed it to have more chondrotoxicity than ropivacaine. When studied the chondrotoxicity was found to be both dose and time dependent. Also, the addition of corticosteroids appeared to worsen the chondrotoxic effects.
Lidocaine, bupivacaine, ropivacaine, levobupivacaine, and mepivacaine were reported to have dose- and time-dependent deleterious effects on chondrocytes that appeared to be made worse by the coadministration of corticosteroids. Ropivacaine at concentrations of 0.5% or less was found to be the least chondrotoxic anesthetic.
I.
回顾当前关于关节腔内局部麻醉药对人膝关节软骨影响的文献。
检索了PubMed、MEDLINE、SCOPUS、PEDro、CINAHL数据库（1990年1月至2018年6月1日），以查找局部麻醉药对人膝关节软骨的影响。
16项研究符合纳入标准，其结果指标评估软骨细胞活力、形态和组织学。使用PRISMA指南进行系统评价。
确定了7项评估利多卡因的研究，其中5项显示出具有统计学意义的软骨毒性作用。14项研究检测了布比卡因，除1项研究外，其余所有研究均显示有软骨毒性作用。8项研究检测了罗哌卡因，发现从0.75%开始存在剂量依赖性软骨毒性。2项评估左旋布比卡因的研究显示有软骨毒性，1项研究表明其软骨毒性比布比卡因更强。1项研究观察了甲哌卡因，显示其软骨毒性比罗哌卡因更强。研究发现软骨毒性具有剂量和时间依赖性。此外，添加皮质类固醇似乎会加重软骨毒性作用。
据报道，利多卡因、布比卡因、罗哌卡因、左旋布比卡因和甲哌卡因对软骨细胞具有剂量和时间依赖性的有害影响，而皮质类固醇的共同给药似乎会使这种影响更严重。发现浓度为0.5%或更低的罗哌卡因是软骨毒性最小的麻醉药。
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