Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleCell Toxicity in Fibroblasts, Tenocytes, and Human Mesenchymal Stem Cells—A Comparison of Necrosis and Apoptosis-Inducing Ability in Ropivacaine, Bupivacaine, and Triamcinolone
Section snippets
Cell Culture
Human dermal fibroblasts and hMSCs derived from adipose tissue from ATCC (American Type Culture Collection), Manassas, VA, were obtained for this study. Tenocytes were gained from rotator cuff tissue of 2 patients undergoing shoulder arthroscopy (44 and 36 years old) from 2011. The cell layer of each group was washed 3 times with phosphate-buffered saline (Thermo Fisher Scientific, Waltham, MA), minced into small pieces with a scalpel, and placed in a 6-well tissue plate (Corning, NY). Then,
Necrosis Rate
Fibroblasts showed high portions of necrotic cells after treatment with 0.5% bupivacaine after 1 hour and 24 hours (P < .05, Fig 2). hMSCs did not significantly differ in cell toxicity when exposed to different agents in various concentrations (Fig 3). Tenocytes also showed a significant reduced amount of necrotic and apoptotic cells at 0.5% bupivacaine after 1 hour and 24 hours (P < .05, Fig 4).
Apoptosis Rate
Apoptosis-induced cell toxicity was not dependent on different cell lines, varying concentrations,
Discussion
The data suggest that ropivacaine and triamcinolone are less toxic and necrosis-inducing than bupivacaine. A high concentration of bupivacaine shows a distinct necrotic influence on fibroblasts and tenocytes. The results show that hMSCs seem to be more resilient against cell-toxic agents. Overall, these findings concur with our hypothesis that bupivacaine has the most necrosis-inducing ability. We also found differences between the necrosis between fibroblasts, tenocytes, and hMSCs.
Many studies
Conclusions
Bupivacaine in concentrations of 0.5% and 0.25% have the most necrosis-inducing effects on fibroblasts and tenocytes. Ropivacaine caused less necrosis than bupivaine. Compared with fibroblasts and tenocytes, hMSCs were not affected by necrosis using ropivacaine, bupivacaine, or triamcinolone. A significant apoptosis-inducing effect of these agents could not be detected between fibroblasts, tenocytes, or hMSCs.
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Regional Anesthesia for Orthobiologic Procedures
2023, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :Although both intravenous (IV) sedation and target site local anesthetic (LA) injection are commonly used, their use is not without risk of complication or adverse effects. In the case of LA use into or around the target tissue, all commercially available LAs have negative effects on tenocytes, chondrocytes, and platelets, with ropivacaine the least and bupivacaine the most harmful to these tissues.1–6 Similarly, many providers use IV sedation, which comes with a host of mild complications such as nausea, vomiting, flu-like symptoms, hypotension, dysesthesia, and headache.7–9
Protocols and Techniques for Orthobiologic Procedures
2023, Physical Medicine and Rehabilitation Clinics of North AmericaPeripheral Joint Injections
2022, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :Furthermore, repeat corticosteroid injections, especially when used with minimal time between injections, seem to increase the risk of complications.10,12 In vitro data have demonstrated that local anesthetics and corticosteroids are harmful to chondrocytes and tenocytes and may reduce the cartilage and meniscus health over time.13–16 Reported complications with HA, PRP, and MSCs have been minimal, with isolated reports of postinjection erythema, swelling, and worsening pain.
Dexamethasone Does not Compensate for Local Anesthetic Cytotoxic Effects on Tenocytes: Morphine or Morphine Plus Dexamethasone May Be a Safe Alternative
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :We cannot exclude regeneration of the cells after a single exposure, nor can we exclude long-term detrimental effects of a single application to the cells due to the experimental setup. Another limitation in this study is that only one concentration per local anesthetic was used in the experiments, although lower concentrations have also been used in clinical practice and studies that have lower cytotoxicity profiles (i.e., .25% bupivacaine and .2% ropivacaine).19,21,66 We focused on the concentrations that have been used in both clinical practice6,45,61,62 and previous studies18-20,60 and that are used for anesthesiological field blocks with LA.
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The authors report that they have no conflicts of interest in the authorship and publication of this article.