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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I just came back from my pre-op visit at the clinic where I'm going to have my knee replaced. They showed me a pump that will be putting pain relievers right into the joint. It sounds wonderful but are there any drawbacks I should know about?

More and more bone and joint surgeries can be done on an outpatient basis these days. As a result, it has been necessary to improve pain management. One of the more popular and successful tools is the intra-articular pain pump. These pumps are designed to deliver a small but steady amount of pain medication right at the site of the surgery. Patients do get good pain relief. They also use fewer narcotic drugs. There are very few problems using these pumps. The most commonly reported complication is chondrolysis. Chondrolysis is a break down of the chondrocytes (cartilage cells) that line the joint. Efforts are being made to study human joints and how they respond to medications dispensed via a pain pump. The most commonly used drugs include lidocaine and bupivacaine with or without epinephrine. Epinephrine is a stress hormone also known as adrenaline. It has the effect of increasing blood supply to the affected area. This can help speed up healing times. A recent study has shown that epinephrine has a negative effect on chondrocytes. It appears that epinephrine may actually cause the death of many chondrocytes. Low doses of lidocaine or bupivacaine without epinephrine can be used safely and effectively for up to 48 hours. Most patients stop using the pain medication after the second day anyway.


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