Leave it under the surface—no one will ever know!!!

By S. Terry Canale, MD

Rapid chondrolysis has been shown to occur in the shoulder following pump infusion of 0.5 percent bupivacaine; recent research by Constance R. Chu, MD, and others has substantiated this fact. As a result, pain pumps have fallen out of favor and have been taken off the market, and lawsuits have been instituted. This issue of AAOS Now takes a closer look at this situation, including an interview with Dr. Chu (“Raising a red flag on intra-articular injections”).

If continuous infusion of bupivacaine (Marcaine) under pressure contributes to the development of chondrolysis in a joint, what happens when a small amount is injected? This becomes an important question for orthopaedic surgeons, particularly when we consider the number of intra-articular bupivacaine injections we have administered over the years. Deleterious effects could have serious consequences.

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