Not to be confused with PCA (patient controlled analgesia) pumps which deliver narcotic pain medications subcutaneously or intravenously to post op patients, these intra-articular shoulder pain pumps deliver anesthetic medication such as lidocaine (xylocaine) or bupivacaine (Marcaine) directly into the shoulder joint to essentially numb the pain. These medications are sometimes mixed with epinephrine to enhance the anesthetic pain management.
According to the studies, the hyaline cartilage in the shoulder joint can be badly damaged or destroyed by these medications leaving patients with limited range of motion in the joint and increased or constant pain.
PAGCL
The condition caused by directly injecting these medications into the joint is known as PAGCL or postarthroscopic glenohumeral chondrolysis. According to one study published in the October 2007 issue of The American Journal of Sports Medicine, nearly 63% of patients using these shoulder pain pumps are at risk of developing PAGCL. The study recommends that patients avoid using these pumps, especially those delivering Marcaine with epinephrine, until the safety of these pumps can be determined.
At present, the only treatment for PAGCL is palliative, which means that the symptoms, particularly the pain, are treated, but the condition is not corrected. Further shoulder surgery is needed to correct the condition, and quite often this involves a total shoulder replacement.
Shoulder Pain Pumps
Intra-articular pain pumps are disposable devices implanted during surgery to deliver post operative anesthetic pain medication through a small catheter directly into the surgical site. Typically they are used for two to five days post surgery and then removed and discarded.
These pumps are most commonly used for post-arthroscopic procedures but can be used for general surgeries as well such as gastric bypass, breast augmentation, cesarean sections, and ligament repair surgery on the knee such as ACL repair. Little is known about the possible effects of this use.
Arthroscopy
Arthroscopic surgery (arthroscopy) is a minimally invasive procedure used to treat a variety of damaged or painful conditions in the shoulder, knee and hip such as arthritis, tendonitis, frozen joints, impingement syndrome and small tears in muscles or tendons.
Although arthroscopy is usually less painful than general surgery which involves a larger incision through multiple layers of skin and muscle, patients do have post operative pain which can be excessive.
Effective Pain Management with Damaging Side Effects
The intra-articular pump was developed to deliver anesthetic medication into the joint or surgical site either in a continuous specific flow rate, or with a variety of patient controlled on-demand bolus features. This route was expected to provide more effective pain control without the use of narcotic pain medications which can cause side effects such as nausea, vomiting and altered levels of consciousness.
As recent studies have shown, far more damaging side effects have resulted from the intra-articular pump, leaving a large number of patients at potential risk for significant joint injury from their use.
Manufacturers Not Notifying MDs
A number of recent shoulder pain pump lawsuits allege that the manufacturers of these devices (such as Stryker, DJO Inc., I-Flow Inc., BREG Inc. and others) have failed to notify the medical community about the possible harm and as a result doctors are just now beginning to be alerted to the potential dangers of the use of these devices.