No abstract

To evaluate the cost and time effectiveness for different anesthesia methods when performing knee arthroscopy, this study compared three different anesthesia methods. Four hundred healthy patients scheduled for knee arthroscopy were randomized to either local anesthesia (LA) (n=200), spinal anesthesia (SA) (n=100) or general anesthesia (GA) (n=100). The LA arthroscopies were performed in a facility set up in our outpatient department without anesthesia service. The SA and GA arthroscopies were performed in our central operating department with full anesthesia service. Comparisons were made between total hospital stay, anesthesia time, surgery time, recovery time, pharmaceutical and total cost. The total hospital time was 130.4 min (SD 35.14, range 63-383) in the LA group compared to 280.4 min (SD 79.29, range 155-589) in the GA group (p<0.001). The total hospital time in the GA group was also shorter than that of 350.3 min (SD 65.37, range 198-502) in the SA group (p<0.001). The time from start of anesthesia to start of surgery was significantly longer in the LA group, 39.2 min (SD 13.13, range 17-87), compared to 20.1 min (SD 4.93, range 11-35) in the SA group and to 17.6 min (SD 4.64, range 9-44) in the GA group. There were no differences in the surgery time for the three groups. The use of LA was shown to save SEK 1011 (Swedish Crowns) per patient compared to SA and GA.

Level I: Prospective, randomized double-blind study without placebo.

Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.

Routines and practice associated to elective knee arthroscopy differed; however, no clear differences in practice were seen between teaching centres, general or local hospitals apart from a lower usage of NSAID for perioperative analgesia. There is an obvious room for further standardisation in the routine handling of patients undergoing elective arthroscopy of the knee.