Device name: Post-operative shoulder pain management pump
Approved uses: Pain management following arthroscopic shoulder surgery
Recent evidence suggests that the use of pain pump catheters temporarily implanted in the shoulder during surgery may be linked to a serious injury know as Postarthroscopic Glenohumeral Chondrolysis (PAGCL)
Pain Pumps and PAGCL
Post Arthroscopic Glenohumeral Chondrolysis (PAGCL) is a devastating complication of arthroscopic shoulder surgery where the cartilage in the shoulder begins to deteriorate months after surgery, causing pain, stiffness, and sometimes the inability to use the affected shoulder.
While PAGCL is relatively uncommon, a study published on July 3, 2007 in The American Journal of Sports Medicine concluded that the use of intra-articular pain pumps with arthroscopic shoulder surgery was highly associated with PAGCL. This association was greatest when the intra-articular pain pumps were used to deliver a combination of the painkillers bupivacaine and epinephrine to the shoulder joint.
Pain Pumps linked to PAGCL cases
In the continuing trend of complications associated with surgeries in the field of shoulder arthoroscopy, the rise of complications involving an intraarticular catheter or pain pump have received much publicity. The problem is known as Postarthroscopic Glenohumeral Chondrolysis (PAGCL), a chronic, oftentimes irreversible condition, causing severe pain, limiting movement, and a host of other complications.
Arthroscopic surgery, a minimally invasive surgical procedure, is oftentimes used to diagnose problems present in the knee, spine, wrist and, more recently, the shoulder. Reports published in a variety of scientific and medical journals have raised questions about the many possible complications associated with arthroscopic surgery within the shoulder joint, especially in cases where individuals have been given a pain pump to help manage their continuing pain. Almost all of the articles have suggested that the possibility of post-surgical problems might outweigh the potential positive effects of the surgery, especially with the correlation between cases of PAGCL and the use of the pain pump.
Pain Pumps Efficient But Risky
A pain pump is a device implanted in the body to assist with pain management. Typically, the user is given a small device which they can use at their discretion to to deliver a dose of pain medication directly to the affected area. Surgeons have widely supported the use of intra-articular pain pumps for effective pain management, not only for the ease of operation, but for the beneficial effects they offer in supporting other pain-killing medications. In the case of shoulder arthroscopy, the device is implanted directly into the shoulder joint where it can quickly and effectively deliver the medication needed.
Medical Professionals Speak Out
However, such efficient relief and temporary benefits have been overshadowed by the potential for extremely damaging side effects. A study published in the July 3 issue of the American Journal of Sports Medicine connected the use of pain pumps with high instances of cases of PAGCL. In fact, the connection was the strongest when the pain pumps were used to deliver a specific combination of two drugs painkillers, bupivacaine and epinephrine. There are several possibilities for the connection, one of which is the high concentration of these painkillers has some association with the cases of PAGCL. The authors of the study recommended that the use of the pain pump with this combination of drugs should be avoided until more studies on the possible link between shoulder pain pumps and PAGCL is better understood.
Another link between the pain pump and cases of PAGCL arose at a meeting of the American Academy of Orthopedic Surgeons in 2006. A paper was presented that also showed evidence that the use of pain pumps in shoulder surgery could be responsible for PAGCL. The study looked at 152 patients who had received anthroscopic shoulder surgeries; 12 of the patients developed PAGCL, and all of the patients who developed the condition had received pain pumps during their surgeries. The use of the pain pump was the only common factor between all of the patients who had developed PAGCL.
Doctors concerned about rise of PAGCL cases
Postarthroscopic Glenohumeral Chondrolysis (PAGCL) is a serious, debilitating condition that occurs after arthroscopic surgery. Arthroscopic surgery, a minimally invasive surgical procedure, is oftentimes used to diagnose problems present in the knee, spine, and wrist. Several reports published in a wide array of scientific and medical journals have raised questions about the many possible complications associated with arthroscopic surgery within the shoulder joint. They have suggested that the possibility of post-surgical problems, especially with a recent spike in cases of PAGCL, might outweigh the potential positive effects of the surgery.