Consumerinjurylawyers.com: Shoulder Pain Pumps

The Use of Bupivacaine in Shoulder Pain Pumps Causes Chondrolysis:

Your shoulder is one of the most moveable joints in your body. The three bones that form this joint are known as the humerus (upper arm bone), clavicle (collar bone) and the scapula (wing back bone) that are connected by tendons, ligaments and muscles. These bones dont fit together very well allowing for movement in all directions, providing for a great range of motion. This means this joint is one of the easiest joints to damage. Dislocated shoulders are a common mishap with this joint. These bones are covered with a certain type of cartilage known as articular cartilage, which acts as a cushion between these bones during movement. This cartilage allows for smooth movement and protects your bones from wear and tear. If for some reason this cartilage is damaged, your bones scrape on each other causing wear on the ends where these bones meet. One of the problems with articular cartilage is that it does not repair itself very well due to the lack of blood vessels. For that reason, severe damage to articular cartilage is generally permanent. Damage to articular cartilage is called chondrolysis. This type of damage to the shoulder after surgical procedures was rare about twenty years ago but new surgical techniques have brought about reports of chondrolysis of the shoulder.

The use of pain pumps after arthroscopic surgery in the shoulder has reportedly caused chondrolysis of the shoulder. Arthroscopic surgery involves placing a plastic tube inside the joint after surgery that allows a local pain medication to be administered that provides better pain relief than oral or intravenous therapies. The Shoulder Pain Pump is a medical device used to pump the pain medication through the plastic tubing into the shoulder joint. Typically, the Shoulder Pain Pump is run for 24 to 48 hours after your surgery to relieve pain from the surgery. The most common pain medication pumped is called bupivacaine (Marcaine, brand name). Bupivacaine is a very powerful local painkiller that has been used for decades but in the past has been administered orally or intravenously with no complications. With the use of this Shoulder Pain Pump and the pain killer bupivacaine providing for direct route to the shoulder, some patients developed chondrolysis with complete loss of articular cartilage with symptoms occurring within 2 months after surgery. Pain pumps had been used on the knee joint following surgery with no reported problems. Reports of shoulder chondrolysis initiated laboratory tests to find out what was happening. Researchers found that direct application of bupivacaine is toxic to chondrocytes (cartilage cells) and kills them. It turns out that the cartilage in the knee joint was much thicker than the shoulder cartilage making the shoulder cartilage much more sensitive to bupivacaine application. This painkiller is also very toxic to the heart when administered in large doses and can lead to cardiac arrest, ventricular arrhythmias and atrioventricular block that have been fatal. The side effects of bupivacaine have been quite severe such that other painkillers are currently being used in place of this drug. To date there is no known cure or effective treatment other than joint replacement.

FDA Orders Safety Label Changes for Bupivacaine:

Apparently, physicians were using shoulder pain pump infusions of bupivacaine as an off-label use. However, the FDA did not clear this off-label use. On February 2010, The FDA Center for Drug Evaluation and Research (DCER) approved a safety labeling change for Marcaine (Bupivacaine HCL). According to the FDA intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have been post-marketing reports of chondrolysis in patients receiving such infusions. The majority of reported cases of chondrolysis have involved the shoulder joint. Cases of glenohumeral chondrolysis have been described in pediatric and adult patients follow intra-articular infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours. There is insufficient information to determine whether shorter infusion periods are not associated with these findings. The time of onset of symptoms, such as joint pain, stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery. Currently, there is no effective treatment for chondrolysis; patients who experienced chondrolysis have required additional diagnostic and therapeutic procedures and some required arthroplasty or shoulder replacement.

If you have experienced chondrolysis with loss of articular cartilage while on a Shoulder Pain Pump administering bupivacaine, you may be entitled to financial compensation. You may want to contact an attorney to see if you can join those who have filed Shoulder Pain Pump Lawsuits.

by: Susan Ardizzoni

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