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Comparison of Ropivacaine and Bupivacaine Toxicity in Human Articular Chondrocytes
Samantha L. Piper, BA1; Hubert T. Kim, MD, PhD2
1 360 Frederick Street #3, San Francisco, CA 94117. E-mail address: Samantha.piper@ucsf.edu
2 SFVAMC (112), 4150 Clement Street, San Francisco, CA 94121. E-mail address: kimh@orthosurg.ucsf.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the San Francisco VA Medical Center, San Francisco, California

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 May 01;90(5):986-991. doi: 10.2106/JBJS.G.01033
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Background: It has been shown that bupivacaine, the most commonly used local anesthetic for postoperative intra-articular use, is cytotoxic to bovine articular chondrocytes in vitro. Ropivacaine is as effective as bupivacaine for intra-articular analgesia and has less systemic toxicity. We compared the in vitro viability of human articular chondrocytes after exposure to bupivacaine, ropivacaine, and saline solution control.

Methods: Macroscopically normal human articular cartilage was harvested from the femoral head or tibial plateau of five patients. Full-thickness cartilage explants and cultured chondrocytes isolated from these patients were treated with 0.9% normal saline solution, 0.5% ropivacaine, or 0.5% bupivacaine for thirty minutes. Twenty-four hours after treatment, chondrocyte viability was measured with use of the LIVE/DEAD Viability/Cytotoxicity Kit for cartilage explants and with use of the CellTiter-Glo Luminescent Cell Viability Assay for cultured chondrocytes.

Results: Chondrocyte viability in cartilage explants was significantly greater after treatment with ropivacaine as compared with bupivacaine (94.4% ± 9.0% compared with 78% ± 12.6%; p = 0.0004). There was no difference in viability after treatment with ropivacaine as compared with saline solution (94.4% ± 9.0% compared with 95.8% ± 5.7%; p = 0.6). The viability of cultured chondrocytes was significantly greater after treatment with ropivacaine as compared with bupivacaine (63.9% ± 19% as compared with 37.4% ± 12% of the value in the saline solution group; p < 0.0001).

Conclusions: In vitro, 0.5% ropivacaine is significantly less toxic than 0.5% bupivacaine in both intact human articular cartilage and chondrocyte culture.

Clinical Relevance: Although bupivacaine is the most commonly used local anesthetic for intra-articular analgesia, the demonstrated toxicity to human articular chondrocytes is cause for concern. The present study demonstrated that ropivacaine is less chondrotoxic than bupivacaine and, therefore, may be safer for intra-articular analgesia.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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