FactFinders for patient safety: Preventing local anesthetic-related complications: Local anesthetic chondrotoxicity and stellate ganglion blocks

Mathew Saffarian; Eric K Holder; Ryan Mattie; Clark C Smith; George Christolias; Jaymin Patel; Zachary L McCormick; Spine Intervention Society's Patient Safety Committee

doi:10.1016/j.inpm.2023.100282

FactFinders for patient safety: Preventing local anesthetic-related complications: Local anesthetic chondrotoxicity and stellate ganglion blocks

Interv Pain Med. 2023 Oct 27;2(4):100282. doi: 10.1016/j.inpm.2023.100282. eCollection 2023 Dec.

Authors

Mathew Saffarian¹, Eric K Holder², Ryan Mattie³, Clark C Smith⁴, George Christolias⁴, Jaymin Patel⁵, Zachary L McCormick⁶; Spine Intervention Society's Patient Safety Committee

Affiliations

¹ Michigan State University, Department of Physical Medicine and Rehabilitation, East Lansing, MI, USA.
² Yale University School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT, USA.
³ Providence Medical Institute, Department of Interventional Pain Management, Providence Cedars-Sinai Tarzana Medical Center, Los Angeles, CA, USA.
⁴ Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, NY, USA.
⁵ Emory University, Department of Orthopaedics, Atlanta, GA, USA.
⁶ University of Utah School of Medicine, Departments of Physical Medicine & Rehabilitation, Salt Lake City, UT, USA.

Abstract

This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of several potential local anesthetic-related complications. Evidence in support of the following facts is presented. (1) Chondrotoxicity: Which Local Anesthetics are Safest for Intraarticular Injection? -- There are drug-, concentration-, and time-dependent chondrotoxic effects that vary between local anesthetics. Current evidence related to commonly used local anesthetics indicates that with exposure to equivalent volumes, bupivacaine, at concentrations of 0.5 % or higher, is the most chondrotoxic agent, while ropivacaine, at concentrations equal to or less than 0.5 %, is the least chondrotoxic in vitro. There is minimal published evidence that confirms these findings in vivo. (2) Minimizing Risks with Stellate Ganglion Blocks -- Evidence suggests that fluoroscopic or ultrasound guidance reduces the risk and increases the accuracy of SGB. Utilizing ultrasound guidance has the added benefit of soft tissue visualization, especially vascular structures, which has the potential to prevent adverse outcomes when compared to the fluoroscopic technique.