Dregalla Ryan C, Uribe Yvette, Bodor Marko
Napa Medical Research Foundation, Napa, California, USA.
Bodor Clinic, Napa, California, USA.
J Orthop Res. 2021 Dec;39(12):2744-2754. doi: 10.1002/jor.25019. Epub 2021 Mar 26.
Local anesthetics are often used at the site of injury or mixed with platelet-rich plasma to reduce pain when treating orthopedic and sports-related injuries. Local anesthetics have been shown to have deleterious effects on stromal cells, but their impact on platelets has not been investigated. In this study, we aimed to assess the effects of lidocaine, bupivacaine, and ropivacaine on platelet health. Based on the deleterious effects of local anesthetics on nucleated cells, we hypothesized that these compounds would affect platelet viability, intracellular physiology, and function. Platelet preparations were derived from randomly selected donors and exposed to lidocaine 1%, bupivacaine 0.75%, ropivacaine 0.5%, and saline at 1:1 and 1:3 ratios. Platelet morphology, viability, intracellular calcium, production of radical oxygen species (ROS), apoptosis, and adhesion were assessed via fluorescent microscopy and flow cytometry. Bupivacaine resulted in increased ROS production, calcium dysregulation, apoptosis, and reduced platelet adhesion. By contrast, ropivacaine and lidocaine were similar to saline in most assays, except for a low degree of mitochondrial stress as evidenced by increased ROS production. Ultimately, bupivacaine 0.75% was harmful to platelets as evidenced by reduced platelet viability, adhesion, and increased apoptosis, whereas lidocaine 1% and ropivacaine 0.5% were relatively safe at the 1:1 and 1:3 dilutions. Clinical significance: Lidocaine 1% and ropivacaine 0.5% can be used at up to a 1:1 ratio with platelet preparations to reduce the pain and discomfort of PRP procedures while maintaining platelet therapeutic potential.
在治疗骨科和运动相关损伤时，局部麻醉剂常被用于损伤部位或与富血小板血浆混合以减轻疼痛。已表明局部麻醉剂对基质细胞有有害影响，但其对血小板的影响尚未得到研究。在本研究中，我们旨在评估利多卡因、布比卡因和罗哌卡因对血小板健康的影响。基于局部麻醉剂对有核细胞的有害影响，我们假设这些化合物会影响血小板活力、细胞内生理学和功能。血小板制剂来自随机选择的供体，并以1:1和1:3的比例分别暴露于1%利多卡因、0.75%布比卡因、0.5%罗哌卡因和生理盐水。通过荧光显微镜和流式细胞术评估血小板形态、活力（活性）、细胞内钙、活性氧（ROS）产生、凋亡和黏附。布比卡因导致活性氧产生增加、钙调节异常、凋亡增加以及血小板黏附减少。相比之下，罗哌卡因和利多卡因在大多数检测中与生理盐水相似，只是活性氧产生增加表明存在低度线粒体应激。最终，0.75%布比卡因对血小板有害，表现为血小板活力和黏附降低以及凋亡增加，而1%利多卡因和0.5%罗哌卡因在1:1和1:3稀释度下相对安全。临床意义：1%利多卡因和0.5%罗哌卡因可与血小板制剂按高达1:1的比例使用，以减轻PRP（富血小板血浆）程序中的疼痛和不适，同时保持血小板的治疗潜力。
