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Pain Management After Bone Reconstruction Surgery Using an Analgesic Bone Cement: A Functional Noninvasive In Vivo Study Using Gait Analysis

  • Manon Dupleichs
    Affiliations
    CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France

    RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France
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  • Martial Masson
    Affiliations
    RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France

    INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M facility, CHU Nantes, Université de Nantes, Nantes, France

    Université de Nantes, UFR Odontologie, Nantes, F-44042, France.
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  • Olivier Gauthier
    Affiliations
    RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France

    ONIRIS, Nantes Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
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  • Maeva Dutilleul
    Affiliations
    RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France

    INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M facility, CHU Nantes, Université de Nantes, Nantes, France

    Université de Nantes, UFR Odontologie, Nantes, F-44042, France.
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  • Jean-Michel Bouler
    Affiliations
    CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France
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  • Author Footnotes
    1 E.V. and P.J. contributed equally to the supervision of this work.
    Elise Verron
    Correspondence
    Address reprint requests to Elise Verron, PharmD, PhD, University of Nantes, CEISAM, 44042 NANTES, France.
    Footnotes
    1 E.V. and P.J. contributed equally to the supervision of this work.
    Affiliations
    CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France

    RMeS-lab, INSERM UMR 1229, University of Nantes, Nantes, France
    Search for articles by this author
  • Author Footnotes
    1 E.V. and P.J. contributed equally to the supervision of this work.
    Pascal Janvier
    Footnotes
    1 E.V. and P.J. contributed equally to the supervision of this work.
    Affiliations
    CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France
    Search for articles by this author
  • Author Footnotes
    1 E.V. and P.J. contributed equally to the supervision of this work.

      Highlights

      • Development of injectable calcium phosphate cements loaded with local anesthetics.
      • Combined cements have the properties required for use in preclinical studies.
      • The CatWalk is an appropriate tool to study implanted analgesic biomaterials.
      • Cements could be part of the global pain management protocol after bone surgery.

      Abstract

      Postoperative pain after bone reconstruction is a serious complication that could jeopardize the global success of a surgery. This pain must be controlled and minimized during the first 3 to 4 postoperative days to prevent it from becoming chronic. In this study, a critical-size bone defect was created at the femoral distal end of rats and filled by an injectable calcium phosphate cement (CPC) loaded or not with local anesthetics (bupivacaine or ropivacaine). A functional evaluation of the gait was performed using the CatWalk system to compare the postoperative pain relief enhanced by the different CPCs after such a bone filling surgery. The results demonstrated significant pain relief during the short-term postoperative period, as shown by the print area and intensity parameters of the operated paw. At 24 hours, the print area decreased by 65%, 42%, and 24%, and the intensity decreased by 25%, 9%, and 1% for unloaded, ropivacaine-loaded, and bupivacaine-loaded CPCs, respectively, compared with the preoperative values. Bupivacaine-loaded CPC provided an earlier return to full functional recovery than ropivacaine-loaded CPC. Moreover, the CPCs retained their biologic and mechanical properties. For all these reasons, anesthetic-loaded CPCs could be part of the global pain management protocol after bone reconstruction surgery such as iliac crest bone grafting procedures.

      Perspective

      Bupivacaine-loaded CPC provided an earlier return to full gait function than ropivacaine-loaded CPC, with preserved bone filling properties. Such analgesic CPCs deserve further in vivo investigation and may be part of the global pain management protocol after bone reconstruction or bone augmentation surgery such as iliac crest bone grafting.

      Key words

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