Beasley, Allen, Crow, Methvin, Portis & Miles, P.C.

The Food and Drug Administration (FDA) has released safety tips for nurses on elastomeric infusion devices, or pain pumps, used during and up to 72 hours after surgery to deliver a continuous amount of local anesthetic directly into the patient’s intra-articular space, or shoulder joint, for postoperative pain control. The FDA has received approximately 35 reports of chondrolysis in patients who received continuous intra-articular infusions with pain pump devices. This type of chondrolysis, called postarthroscopic glenhumeral chondrolysis (PAGCL), occurs when the shoulder cartilage is worn away, causing bone to rub against bone. It is a severe, life-altering complication that is usually irreversible. Many patients require a total shoulder replacement.

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Pros and cons of various types of intra-articular injections, continuous catheters and their place in the anesthesiologists’ armamentarium was presented by Asokumar Buvanendran, MD, director of orthopedic anesthesia and associate professor of anesthesiology at Rush University Medical Center in Chicago, at the 2010 annual spring meeting of the American Society of Regional Anesthesia and Pain Medicine.

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Pain pumps are getting a bad rap lately, thanks to the emergence of chondrolysis, a debilitating condition that was once unheard of in the shoulder joint but is now affecting hundreds who have undergone shoulder surgery. But Pearland, Texas, Dr. Leo Lapuerta says the devices are not banned for all medical procedures and that they are particularly beneficial for plastic surgeries.

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Postarthroscopic glenohumeral chondrolysis, or chondrolysis of the shoulder, was once unheard of, but surgeons are beginning to see the debilitating condition affect more and more patients who have previously had shoulder surgery, according to Ortho Super Site. Chondrolysis occurs when the cartilage in the shoulder wears away causing bone to rub against bone. Symptoms of chondrolysis often present between three and 12 months after shoulder surgery and begin as a deep ache that progresses to severe pain and loss of motion. While the cause of chondrolysis is still up for debate, one likely culprit is the use of intra-articular pain pumps during the shoulder surgery.

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Much has been reported lately about chondrolysis of the shoulder, or Postarthroscopic Glenohumeral Chondrolysis (PAGCL). So what is chondrolysis and why is it getting so much face time? Chondrolysis is the destruction of the cartilage in a joint. It is generally a rare condition anywhere in the body, but it has been most often heard of in hip joints most often from birth defects. Before the 1990s, chondrolysis in the shoulder was never seen.

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Patients who used pain pump devices to relieve pain from shoulder surgery are at risk for permanent joint damage, according to recent studies. Pain pumps are balloon-like devices that are filled with anesthetics that deliver medication directly into the surgical space via a catheter. The medication is slowly released into the joint space for up to 72 hours following surgery and then the catheter is removed by the patient.

While this use of pain pumps was a convenient way to relieve pain from surgery, it also resulted in a surprisingly high number of cases of a painful and debilitating deterioration of cartilage in the shoulder joint known as chondrolysis, specifically Postarthroscopic Glenhumeral Chondrolysis (PAGCL). The condition is permanent and many who suffer from it require shoulder replacement surgery.

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Gregg Zaun will have shoulder surgery next week, which will end the season early for the Milwaukee Brewers catcher. It may also mark the end of his career. “I’m not in a situation anymore where I need to play. I don’t need to play. I don’t need to play Major League Baseball to validate myself as a person,” Zaun said before the Brewers’ game against the Chicago Cubs. “Do I want to play? That’s a different story. It’s too uncertain to tell. I’m really upset about having surgery and my season being over.”

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Just as the baseball season was getting underway, Tampa Bay Rays J.P. Howell had surgery on his left shoulder, ending his season prematurely. The left-handed reliever had to stop a simulated game last week just after starting because of discomfort in his shoulder. Two days later he was in surgery. Howell is expected to be recovered enough to play in the 2011 season.

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I-Flow has agreed to settle five lawsuits from plaintiffs who say the company’s pain pump device used during shoulder repair surgery caused them to develop a painful and debilitating condition known as chondrolysis. The announcement follows a ruling by a federal judge in Ohio who rejected efforts to have the cases dismissed. The lawsuits had been consolidated for a trial that was scheduled to begin late last month. All of the plaintiffs alleged that the pain pumps manufactured by I-Flow to infuse pain medication into the shoulder joint during and after arthroscopic surgery destroyed the shoulder cartilage, causing chondrolysis.

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An Oregon Appeals Court denied a request by defendant I-Flow for a new trial in Mulnomah County Circuit Court following a January 22 jury verdict against the pain pump manufacturer. Jurors awarded $5.475 million for damaging the right shoulder of Portland, Oregon, resident Matthew Beale, placing blame on the On-Q Painbuster infusion pain pump device manufactured and marketed by I-Flow.

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