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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.
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.
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.
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.
Whitney Moore was in prime physical condition just a few years ago. She played junior varsity soccer at West Virginia University before opening a strength and conditioning business for young athletes. In 2004, she injured her shoulder playing soccer and had surgery to repair it. But the surgery only made her shoulder worse. Moore developed a once-rare condition known as chondrolysis, in which the cartilage in the joint wears away causing bone to rub against bone.
UCLA forward James Keefe will miss two to three weeks with the team to recovery from a dislocated left shoulder. The senior was injured during the first half of UCLA’s game against New Mexico State on December 15th. The injury occurred on the same shoulder that required surgery for a torn labrum in 2007.
Jean-Thenistor Pascal, the Haitian-Quebecker professional boxer and current WBC Light Heavyweight Champion, underwent arthroscopic surgery on his right shoulder this week and will be unable to train or fight for about nine weeks. The boxer hurt his shoulder while successfully defending his title against Adrian Diaconu last week.
Five lawsuits against manufacturers of pain pumps and pharmaceutical companies on behalf of 28 people were filed in Los Angeles County Superior Court this month, alleging fraud, breach of warranty and products liability, saying the makers of the products continued to market the pain pumps as mitigation for shoulder joints despite the specific use of those products not being approved by the Food and Drug Administration (FDA). The lawsuits also allege that the pain pump devices caused a painful and debilitating condition known as postarthroscopic glenohumeral chondrolysis (PAGCL), in which the cartilage in the shoulder joint wears away causing bone to rub against bone.
The Food and Drug Administration (FDA) is warning orthopedic and anesthesia health care providers and hospital risk managers not to continuously infuse local anesthetics directly into the intra-articular joint space because this use of anesthetics has led to a painful and debilitating condition known as chondrolysis, or the decaying and destruction of the cartilage.
In light of a recent report released by the U. S. Food and Drug Administration that confirms the link between chondrolysis and pain pump use, Joseph A. Carrese, MD, MPH, an expert in bioethics, has issued an opinion stating that physicians have a responsiblity to inform former patients on whom they used the device of the possible risk.
It is Dr. Carrese’s opinion that “to do otherwise would be a failure of expected ethical and professional conduct, and in turn a failure of good clinical practice.”
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