Effect of a single intra-articular injection of bupivacaine on synovial fluid prostaglandin E2 concentrations in normal canine stifles

Intra-articular bupivacaine is a common analgesic used in dogs with orthopedic disease. Bupivacaine has been linked to chondrotoxicity. The mechanism for bupivacaine's chondrotoxicity is unknown, but may involve inflammation. Prostaglandin E2 (PGE2) is an inflammatory mediator and a marker of joint inflammation. The aim of this study was to compare synovial fluid PGE2 concentrations after a single intra-articular injection of bupivacaine with a saline control in normal canine stifles. We hypothesized that bupivacaine stifles would have a significantly elevated PGE2 concentration compared to controls. Stifles from eight healthy, adult Beagles were randomly selected as the treated stifle and infused with bupivacaine. The contralateral stifle was injected with saline. Synovial fluid was collected before and after injection. PGE2 was quantified using a commercial ELISA. Data were transformed and mixed model ANOVA was performed with significance set at p<0.05. There were no significant differences in PGE2 concentration between treatment groups or times. Samples acquired with one or two aspiration attempts had significantly lower PGE2 concentrations than samples with =3 aspiration attempts (p=0.001). When adjusted for number of attempts, PGE2 concentrations were significantly higher 24 (p=0.003) and 48 (p=0.041) hours after injection compared to baseline in the bupivacaine group, but not in the saline group. Intra-articular bupivacaine injection did not result in increased synovial fluid PGE2 concentrations compared to controls; however, multiple aspiration attempts did, suggesting that synovial fluid PGE2 concentration is sensitive to multiple fluid collection attempts. Future studies investigating synovial fluid inflammatory mediators should consider methods to minimize aspiration attempts.