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Published: June 2010

Adverse reactions associated with intra-articular use of local anaesthetics

Prescriber Update 31(2): 15
June 2010

The US Food and Drug Administration (FDA) has recently reported that it has received post-marketing reports of chondrolysis in patients given continuous intra-articular infusions of local anaesthetics.1 The local anaesthetics were infused for extended periods of time and were given with or without adrenaline to control pain following surgery.

Almost all of the cases reported to the FDA involved the shoulder joint, with a variable time to onset of symptoms of joint pain, stiffness, and loss of motion. There is currently no effective treatment for chondrolysis; these patients have required additional procedures including surgery.

In New Zealand, lignocaine solutions are indicated for the production of local or regional anaesthesia by the following techniques:

Although there have been no reports in New Zealand to date, prescribers are advised that lignocaine should not be used as a continuous infusion in the joint space to control pain following surgery.

Prescribers are reminded to report any suspected adverse drug reactions associated with intra-articular use of local anaesthetics to CARM.

References
  1. FDA. 13 November 2009 Updated 16 February 2010. Information for Health Professionals - Intravenous Promethazine and Severe Tissue Injury, Including Gangrene. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm190302.htm. Accessed 12 April 2010
  2. Astra Zeneca Limited. 3 July 2007. Xylocaine injection data sheet. www.medsafe.govt.nz/profs/Datasheet/x/XylocaineAndAdrenalineinj.pdf

 

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