Local anaesthetics and chondrotoxicty: What is the evidence?

Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years.

We have reviewed the available basic science literature focusing on the studies assessing the effect of exposing articular chondrocytes to local anaesthetic agents. We attempt to highlight the key findings and, where possible, extrapolate the laboratory findings to the operating theatre.

Basic science reports are analysed according to their setting of either in vitro, ex vivo or in vivo and according to cell line. A majority of work to date has been done using in vitro models. Only a small number of in vivo models using animal cell lines have been used and the best of these have conflicting results with regard lasting toxicity secondary to local anaesthetic exposure.

Numerous reports suggest a toxic effect of local anaesthetic agents on articular chondrocytes, however, further work is warranted to establish the precise mechanism of toxicity and whether or not single bolus administration results in long-term deleterious outcomes. Determining the ideal in vitro model will help in extrapolating laboratory data to the operating theatre.