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Bone Joint Res. 2013 Dec 11;2(12):270-5. doi: 10.1302/2046-3758.212.2000216. Print 2013.

Co-administration of hyaluronic acid with local anaesthetics shows lower cytotoxicity than local anaesthetic treatment alone in bovine articular chondrocytes.

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University of California, San Francisco, UCSFDepartment of Orthopaedic Surgery, 1500 OwensStreet, San Francisco, California94158, USA.



To study the effect of hyaluronic acid (HA) on local anaesthetic chondrotoxicity in vitro.


Chondrocytes were harvested from bovine femoral condyle cartilage and isolated using collagenase-containing media. At 24 hours after seeding 15 000 cells per well onto a 96-well plate, chondrocytes were treated with media (DMEM/F12 + ITS), PBS, 1:1 lidocaine (2%):PBS, 1:1 bupivacaine (0.5%):PBS, 1:1 lidocaine (2%):HA, 1:1 bupivacaine (0. 5%):HA, or 1:1 HA:PBS for one hour. Following treatment, groups had conditions removed and 24-hour incubation. Cell viability was assessed using PrestoBlue and confirmed visually using fluorescence microscopy.


Media-treated groups had a mean of 1.55×10(4) cells/well (sem 783). All treated cells showed statistically significant reduced viability when compared with media alone (all p < 0.003). Cells treated with bupivacaine + HA (6.70×10(3) cells/well (sem 1.10×10(3))) survived significantly more than bupivacaine (2.44×10(3) cells/well (sem 830)) (p < 0.001). Lidocaine + HA (1.45×10(3) cells/well (sem 596)) was not significantly more cytotoxic than lidocaine (2.24×10(3) cells/well (sem 341)) (p = 0.999). There was no statistical difference between the chondrotoxicities of PBS (8.49×10(3) cells/well (sem 730) cells/well) and HA (4.75×10(3) cells/well (sem 886)) (p = 0.294).


HA co-administration reduced anaesthetic cytotoxicity with bupivacaine but not lidocaine, suggesting different mechanisms of injury between the two. Co-administered intra-articular injections of HA with bupivacaine, but not lidocaine, may protect articular chondrocytes from local anaesthetic-associated death. Cite this article: Bone Joint Res 2013;2:270-5.


Chondrocytes; Hyaluronic acid; Intra-articular injections; Local anaesthetic; Osteoarthritis

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