Wayne State University School of Medicine.
Arthroscopy. 2022 Jun;38(6):1996-1998. doi: 10.1016/j.arthro.2022.03.003.
Periarticular and intra-articular injections are regularly used by orthopaedic surgeons both in the clinic and operative setting. These injections include the use of local anesthetics, nonsteroidal anti-inflammatories, steroidal anti-inflammatories, and other classes of pharmaceuticals. Local anesthetics can be injected alone or in conjunction with other pharmaceuticals to maximize pain control and to minimize narcotic use as part of a multimodal pain control algorithm. Use of intra-articular local anesthetics has been shown to improve postoperative pain scores and reduce intravenous and oral narcotic consumption and narcotic-related side effects, such as constipation, sedation, depression, respiratory depression, and long-term abuse potential. However, there have been reports of chondrolysis and other side effects from these injections. In general, it can be said that lidocaine is more chondrotoxic than bupivacaine and that methylprednisolone is more chondrotoxic when combined with either lidocaine or bupivacaine. Ropivacaine with steroid maybe less chondrotoxic, but this has yet to be established. It has been shown that ropivacaine with steroids may be toxic to chondrocytes as well as bovine tenocytes. In addition, it can be generalized that longer exposures, such as an indwelling, intra-articular catheter, are more chondrotoxic than shorter exposures, such as an intra-articular injection. Greater concentrations of lidocaine and bupivacaine (i.e., 1% vs 2% and 0.25% vs 0.5%, respectively) are more toxic to chondrocytes. Cellular morphine studies have resulted in conflicting reports of whether or not it is chondrotoxic. Both ketorolac and acetaminophen have been shown to decrease postoperative pain, but ketorolac also has been shown to be chondrotoxic in a human chondrocyte model. Doing the right thing for our patients' pain may be the wrong thing for their articular cartilage. Expansion of indications for these injections should be approached with caution.
关节周围和关节内注射在骨科医生的临床和手术环境中经常使用。这些注射包括使用局部麻醉剂、非甾体抗炎药、甾体抗炎药和其他类别的药物。局部麻醉剂可以单独使用或与其他药物联合使用，以最大限度地控制疼痛，并最大限度地减少作为多模式疼痛控制算法一部分的阿片类药物的使用。关节内局部麻醉剂的使用已被证明可以改善术后疼痛评分，并减少静脉和口服阿片类药物的消耗以及阿片类药物相关的副作用，如便秘、镇静、抑郁、呼吸抑制和长期滥用的可能性。然而，这些注射也有报道称会引起软骨溶解和其他副作用。一般来说，可以说利多卡因比布比卡因更具软骨毒性，而且当与利多卡因或布比卡因联合使用时，甲泼尼龙的软骨毒性更大。与类固醇联合使用的罗哌卡因可能毒性较小，但这尚未得到证实。已经表明，罗哌卡因与类固醇可能对软骨细胞和牛腱细胞都有毒性。此外，可以概括地说，较长时间的暴露，如留置关节内导管，比较短时间的暴露，如关节内注射更具软骨毒性。较高浓度的利多卡因和布比卡因（即 1%比 2%和 0.25%比 0.5%）对软骨细胞的毒性更大。细胞吗啡研究对其是否具有软骨毒性的结果存在相互矛盾的报告。酮咯酸和对乙酰氨基酚都已被证明可以减轻术后疼痛，但酮咯酸在人软骨细胞模型中也被证明具有软骨毒性。为患者的疼痛做正确的事情可能对他们的关节软骨是错误的。扩大这些注射的适应症应谨慎行事。
