Reactions 1433 - 5 Jan 2013

SRopivacaine

Chondrolysis following intra-articularadministration: case report

A 29-year-old man developed chondrolysis of the elbowjoint following intra-articular administration of ropivacaineduring surgery.

The man, a competitive rugby player, was undergoingarthroscopy to treat post-traumatic arthrosis in his right elbowafter a rugby injury. At the end of the procedure, a continuousinfusion pain catheter was inserted, administering 0.20%ropivacaine for 48 hours [dosage not stated]. He did wellinitially, but 3.5 months after the surgery he started toexperience elbow pain, swelling, locking and loss of motion.Laboratory tests did not show any evidence of infection. X-raysrevealed some interval loss of joint space in the elbow.Magnetic resonance arthrography indicated bone oedema andsevere loss of articular cartilage, compatible with chondrolysis.

The man was given NSAIDs and opioid analgesics, andcontinued with physical therapy, but his symptoms were notameliorated. At his most recent follow-up, he had a 20° arc ofactive elbow motion, 20° of pronation, and no supination. X-rays demonstrated severe loss of joint space in the elbow. Hewas still considering various treatment options.

Author comment: "[We report a] case of post-arthroscopicchondrolysis in the elbow, which we hypothesize was due tochondrotoxicity resulting from the continuous intra-articularinfusion of ropivacaine".Kinkartz JD, et al. Post-arthroscopic elbow chondrolysis after continuous intra-articular ropivacaine infusion. Journal of Shoulder and Elbow Surgery 21: e1-e5,No. 11, Nov 2012. Available from: URL: http://dx.doi.org/10.1016/j.jse.2012.06.013 - USA 803081468

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