The FDA has notified healthcare professionals in the US of reports of adverse reactions associated with the administration of local anaesthetics (bupivacaine, chlorprocaine, lidocaine, mepivacaine, procaine, ropivacaine) via intra-articular infusion.

The Agency has received 35 reports of chondrolysis (necrosis and destruction of cartilage) in patients given continuous intra-articular infusions of local anaesthetics (with and without epinephrine) to control post-surgical pain.  The local anaesthetics were infused for extended periods of time (48 to 72 hours) directly into the intra-articular space using an elastomeric pump. Joint pain, stiffness, and loss of motion were reported as early as the second month after receiving the infusion. In more than half of these reports, the patients required additional surgery, including arthroscopy or arthroplasty.

The FDA notes that no local anaesthetics are indicated for continuous intra-articular postoperative infusions; in addition the Agency has not cleared any infusion devices with an indication for use in intra-articular infusion of local anaesthetics. 

Please see the link below for details of further management considerations for healthcare professionals, information for patients, and a data summary of the 35 reports.