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.
The discussion grew out of recent concerns about the safety and efficacy of intra-articular injections and catheters following recent cases of glenhumeral chondrolysis following shoulder surgery.
Such use of pain pumps in shoulder surgery has never been approved by the Food and Drug Administration (FDA), yet manufacturers of these pain pumps began instructing surgeons to use them in shoulder surgery after seeing good results using the intra-articular injections after total knee arthroplasty.
However, by 2007, early reports of the painful and debilitating adverse event chondrolysis began surfacing. One early study found 12 out of 177 patients had developed chondrolysis following shoulder surgery with intra-articular pain pumps.
In November 2009, the FDA announced it has reviewed 35 cases of chondrolysis in patients who had used pain pumps following shoulder surgery. “The significance of this injury to otherwise healthy young adults warrants notification to health care professionals,” the agency said in a notice to health care professionals.
At least 150 lawsuits have been filed nationwide against the manufacturers of pain pumps from patients who developed chondrolysis who claim they were not warned that by using pain pumps in this manner they were at risk of serious injury. In January, an Oregon jury awarded $5.5 million to one plaintiff with chondrolysis who sued pain pump manufacturers.