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Placement of a pain pump at the site of a surgery (hip shoulder knee etc.) has been shown by studies to cause serious cartilage damage in some patients. The medical term for such a pain pump is "intra-articular pain pump" and the cartilage damage is called Chondrolysis. The problem has been the subject of litigation and widely reported at leading legal/medical websites such as Pain Pumps and cartilege damage and leading lawfirms such as Beasley Allen.
The pain pump is designed to deliver medication directly to the surgical wound site or in close proximity to the nerves associated with the surgical area for pain management. The pain pump infuses the medication at an hourly flow rate or combination of an hourly flow rate and controlled large doses. The condition is referred to as PAGCL for "postarthroscopic glenohumeral chondrolysis":
The condition caused by directly injecting these medications into the joint is known as PAGCL or postarthroscopic glenohumeral chondrolysis. According to one study published in the October 2007 issue of The American Journal of Sports Medicine nearly 63% of patients using these shoulder pain pumps are at risk of developing PAGCL. The study recommends that patients avoid using these pumps especially those delivering Marcaine with epinephrine until the safety of these pumps can be determined.
A recent study published by The American Journal of Sports Medicine identified intra-articular pain pumps (post surgery pain pumps) as the likely cause of a condition known as chondrolysis.
B. Hansen and colleagues presented a paper entitled "Post-arthroscopic Shoulder Chondrolysis With Associated Intra-articular Pain Pump Catheter Use." This group of investigators reviewed the charts of 152 patients who underwent 177 shoulder arthroscopies by the senior author between January 1 2003 and December 31 2005 for postarthroscopic chondrolysis. Demographic information procedure implant and suture type thermal probe use and intra-articular pain catheter use were evaluated. All cases who developed chondrolysis also underwent rheumatologic and infection work-ups. Twelve shoulders in 10 patients who underwent arthroscopic stabilization developed chondrolysis. Eighty-three percent of these required a subsequent procedure. All patients who developed chondrolysis had been treated postoperatively with an intra-articular pain pump catheter with bupivacaine 0.25% with epinephrine 1:200000. Seven other patients treated with intra-articular pain pump catheters had not developed chondrolysis at the time of review. None of the other patients developed chondrolysis in this group. No other factors were found to be in common. All chondrolysis cases occurred after beginning the use of a larger pain pump which infused this medication at 4.16 cc/hour over 2 or 3 days. Although the exact etiology and mechanism of chondrolysis are still unknown the study authors believe that there is a significant and previously unrecognized risk associated with the use of intra-articular pain pump catheters and bupivacaine with epinephrine. One of the possible reasons is that the pH of bupivacaine with epinephrine is between 3.5 and 5.5 and that the low pH may play a role. The study authors conclude that intra-articular pain pump catheters should be used with caution until the safety of constantly infusing local anesthetics intra-articularly is better defined.
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