Spinal versus intra-articular anesthesia in arthroscopic knee surgery.
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Published:
Nov 8, 2016
Keywords:
Knee arthroscopy, local anesthesia, intraarticular.
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Abstract
Background: Knee arthroscopy is the most common surgical procedure to treat patients with meniscal and / or chondral injuries. The aim of this study was to compare the efficacy of spinal vs. intra-articular anesthesia in knee arthroscopy, to assess the quality of anesthesia, to describe the incidence of adverse effects and to determine the complications in both cases.Material and Methods: Prospective, Level of evidence I, randomized, in which two anesthetic procedures were compared by evaluating age, duration of surgery, duration of anesthesia, duration of hospitalization, pain (VAS), patient satisfaction and costs. Student's t test was used for the realization of statistics and probabilities. Level of significance: p <0.05. Results: Of the total, 35 were operated on under intra-articular anesthesia, and the same number of patients under spinal anesthesia. Hospital stay was longer in the spinal anesthesia group 7.34 hours. While in the intra-articular anesthesia group, average hospital stay was 3.43 hours, giving a p = less than 0.0001. The cost variable showed a significant difference in favor of intra-articular anesthesia compared to spinal anesthesia with a cost of less than 0.0001 p.Discussion Conclusion: The advantages found in favor of intra-articular anesthesia were: shortened hospital stays, avoidance of the undesirable effects of spinal anesthesia: motor block, nausea, vomiting, hypotension, transient loss of urinary sphincter and urinary retention (distended bladder), reduced costs and increased patient acceptance.
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Marangoni, L. D., Giacossa, R., Malvarez, A., Bitar, I., Bustos, D., Galera, H., & Bertiche, P. (2016). Spinal versus intra-articular anesthesia in arthroscopic knee surgery. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(4), 258-263. https://doi.org/10.15417/562
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Clinical Research
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References
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3. Vidal F, Garcia M. Anestesia intra-articular en la artroscopia de la rodilla, estudio comparativo doble ciego. Rev Mex Ortop Traum (2000) 14: 196-199.
4. Goranson BD, Lang S, Cassidy JD, Dust WN, McKerrell J. A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy. Can J Anaesth (1997) 44:371-6.
5. Hultin J. Knee arthroscopy using local anesthesia. Arthroscopy (1992) 2:239-241.
6. Cannon WD, Morgan CD Meniscal repair-instructional course lectures. J Bone Joint Surg (Am) (1994) 76: 294-311.
7. Graft D,Good R. Delayed hipersensitivity reaction of the knee a inyection of arthroscopy portals with bupivacaine (marcaine). Arthroscopy (1994) 3:305-308.
8. Bollini, CA, Arce G, Lacroze P . Anestesia local intraarticular para la artroscopia de rodilla: experiencia clínica. Rev Arg Anestesiol (1994) abr-jun.
9. Williams CR, Thomas NP. A prospective trial of local versus general anaesthesia for arthroscopic surgery of the knee. Ann R Coll Surg Engl (1997) 79: 345-8.
10. Karaoglu S, Dogru K, Kabak , Inan M, Hlici M. Effects of epinephrine in local anesthetic mixtures on hemodynamics and view quality during knee arthroscopy. Arthroscopy (2000) 16: 183-190.
11. McGinty JB, Matza RA. Arthroscopy of the knee. Evaluation of an out-patient procedure under local anesthesia. J Bone Joint Surg Am (1978) 60:787-789.
12. Ben David B, De Meo PJ, Lucyk C, Solosko D. A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusión for outpatient knee arthroscopy. Anesth Analg (2001) 93:319-325.
13. Jacobson E, Forssblad M, Rosenberg J, Westman L and Weidenhielm L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy (2000) 16: 183-190.
14. Shapiro MS, Safran MR, Crockett H, and Finerman GAM. Local anesthesia for knee arthroscopy, efficacy and cost benefits. AJSM (1995) 23: 76-119.
15. Pellaci F, Beluzzi R, Martini A. Outpatient arthroscopy. Chir Organi Mov (1996) 81:165-172.
16. Horlocker TT,Hebl jr, Anesthesia for outpatient knee arthroscopy: is there an optimal technique?. Reg Anesth Pain Med. (2003) 28:58-63.
17. Illigan KA, Mowbray MJ, Mulrooney L, Standen PJ.Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patient. Anaesthesia (1988) 43: 563-4.
18. Jacobson E, Forssblad M, Weidenhielm L, Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up. Am J Sports Med (2002); 30:61-5.
19. Raja SN, Dickstein RE, Johnson CA Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 1992;77:1143-7.
20. Reuben SS, Connelly NR Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular bupivacaine and ketorolac. Anesth Analg 1995; 80: 1154-7.
21. Pedowitz Tourniquet induced neuromuscular injury,. Acta Orthop Scand 1991;62 (Suppl 245):1-33.
22. Gersoff WK, Ruwe P, Jokl P, Panjabi M The effect of tourniquet pressure on muscle function. Am J Sports Med; 1989 17:123-7.
23. Maldini B, Miskulin M, Antolić S, Goranović T, Sakić-Zdravcević K, Gudelj G. Coll Local or spinal anesthesia in acute knee surgery. Antropol 2010; 34 Suppl 1; 247-54.
24. Forssblad M, Jacobson E, Weidenhielm L. Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc 2004; 12:344-9.
25. Birkner W, Henche HR. 18 years of experience in knee arthroscopy under local anesthesia. Diagn Ther Endosc 1996; 3 (1): 1-7.
26. Baker JF, Mulhall KJ. Local anaesthetics and chondrotoxicty: What is the evidence? Knee Surg Sports Traumatol Arthrosc 2012; 20: 2294-2301.
27. Townshend D, Emmerson K, Jones S, Partington P, Muller S. Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the kneeA prospective, randomised double-blinded trial. J Bone Joint Surg Br; 2009; 91B: 601-3
28. Noyes FR, Fleckenstein CM, and Barber-Westin SD. The Development of Postoperative Knee Chondrolysis After Intra-Articular Pain Pump Infusion of an Anesthetic Medication A Series of Twenty-One Cases. J Bone Joint Surg Am. 2012;94:1448-57.
29. Maldini B, Miskulin M, Antolic S, Goranovic T, Sakic-Zdravcevic K and Gudelj K. Local or Spinal Anesthesia in Acute Knee Surgery. Coll. Antropol; (2010); 34 (Suppl) 1: 247-254.
30. Buchko JZ, Gurney-Dunlop T and Shin JJ. Pump Catheter After Arthroscopic ACL Reconstruction Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain. Am J Sports Med 2015 43: 337.
31. Campo G, Kerkhoffs GMMJ. Sierevelt IN, Weeseman RR, Van der Vis HM, Albers GHR. A randomised controlled trial for the effectiveness of intraarticular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (Dutch Pain Relief after Arthroscopy)-trial. Knee Surg Sports Traumatol Arthrosc (2012) 20:239–244.
32. Lintner S, Shawen S, Lohnes J, Levy A, and Garrett W. Local Anesthesia in Outpatient Knee Arthroscopy: A Comparison of Efficacy and Cost. Arthroscopy: The Journal of Arthroscopic and Related Surgery;1996; 12: 482-488.
2. Mondino Juan Alberto. Artroscopia de rodilla con anestesia local. Artroscopia (2006) 13:102-110.
3. Vidal F, Garcia M. Anestesia intra-articular en la artroscopia de la rodilla, estudio comparativo doble ciego. Rev Mex Ortop Traum (2000) 14: 196-199.
4. Goranson BD, Lang S, Cassidy JD, Dust WN, McKerrell J. A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy. Can J Anaesth (1997) 44:371-6.
5. Hultin J. Knee arthroscopy using local anesthesia. Arthroscopy (1992) 2:239-241.
6. Cannon WD, Morgan CD Meniscal repair-instructional course lectures. J Bone Joint Surg (Am) (1994) 76: 294-311.
7. Graft D,Good R. Delayed hipersensitivity reaction of the knee a inyection of arthroscopy portals with bupivacaine (marcaine). Arthroscopy (1994) 3:305-308.
8. Bollini, CA, Arce G, Lacroze P . Anestesia local intraarticular para la artroscopia de rodilla: experiencia clínica. Rev Arg Anestesiol (1994) abr-jun.
9. Williams CR, Thomas NP. A prospective trial of local versus general anaesthesia for arthroscopic surgery of the knee. Ann R Coll Surg Engl (1997) 79: 345-8.
10. Karaoglu S, Dogru K, Kabak , Inan M, Hlici M. Effects of epinephrine in local anesthetic mixtures on hemodynamics and view quality during knee arthroscopy. Arthroscopy (2000) 16: 183-190.
11. McGinty JB, Matza RA. Arthroscopy of the knee. Evaluation of an out-patient procedure under local anesthesia. J Bone Joint Surg Am (1978) 60:787-789.
12. Ben David B, De Meo PJ, Lucyk C, Solosko D. A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusión for outpatient knee arthroscopy. Anesth Analg (2001) 93:319-325.
13. Jacobson E, Forssblad M, Rosenberg J, Westman L and Weidenhielm L. Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy (2000) 16: 183-190.
14. Shapiro MS, Safran MR, Crockett H, and Finerman GAM. Local anesthesia for knee arthroscopy, efficacy and cost benefits. AJSM (1995) 23: 76-119.
15. Pellaci F, Beluzzi R, Martini A. Outpatient arthroscopy. Chir Organi Mov (1996) 81:165-172.
16. Horlocker TT,Hebl jr, Anesthesia for outpatient knee arthroscopy: is there an optimal technique?. Reg Anesth Pain Med. (2003) 28:58-63.
17. Illigan KA, Mowbray MJ, Mulrooney L, Standen PJ.Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patient. Anaesthesia (1988) 43: 563-4.
18. Jacobson E, Forssblad M, Weidenhielm L, Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up. Am J Sports Med (2002); 30:61-5.
19. Raja SN, Dickstein RE, Johnson CA Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 1992;77:1143-7.
20. Reuben SS, Connelly NR Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular bupivacaine and ketorolac. Anesth Analg 1995; 80: 1154-7.
21. Pedowitz Tourniquet induced neuromuscular injury,. Acta Orthop Scand 1991;62 (Suppl 245):1-33.
22. Gersoff WK, Ruwe P, Jokl P, Panjabi M The effect of tourniquet pressure on muscle function. Am J Sports Med; 1989 17:123-7.
23. Maldini B, Miskulin M, Antolić S, Goranović T, Sakić-Zdravcević K, Gudelj G. Coll Local or spinal anesthesia in acute knee surgery. Antropol 2010; 34 Suppl 1; 247-54.
24. Forssblad M, Jacobson E, Weidenhielm L. Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc 2004; 12:344-9.
25. Birkner W, Henche HR. 18 years of experience in knee arthroscopy under local anesthesia. Diagn Ther Endosc 1996; 3 (1): 1-7.
26. Baker JF, Mulhall KJ. Local anaesthetics and chondrotoxicty: What is the evidence? Knee Surg Sports Traumatol Arthrosc 2012; 20: 2294-2301.
27. Townshend D, Emmerson K, Jones S, Partington P, Muller S. Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the kneeA prospective, randomised double-blinded trial. J Bone Joint Surg Br; 2009; 91B: 601-3
28. Noyes FR, Fleckenstein CM, and Barber-Westin SD. The Development of Postoperative Knee Chondrolysis After Intra-Articular Pain Pump Infusion of an Anesthetic Medication A Series of Twenty-One Cases. J Bone Joint Surg Am. 2012;94:1448-57.
29. Maldini B, Miskulin M, Antolic S, Goranovic T, Sakic-Zdravcevic K and Gudelj K. Local or Spinal Anesthesia in Acute Knee Surgery. Coll. Antropol; (2010); 34 (Suppl) 1: 247-254.
30. Buchko JZ, Gurney-Dunlop T and Shin JJ. Pump Catheter After Arthroscopic ACL Reconstruction Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain. Am J Sports Med 2015 43: 337.
31. Campo G, Kerkhoffs GMMJ. Sierevelt IN, Weeseman RR, Van der Vis HM, Albers GHR. A randomised controlled trial for the effectiveness of intraarticular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (Dutch Pain Relief after Arthroscopy)-trial. Knee Surg Sports Traumatol Arthrosc (2012) 20:239–244.
32. Lintner S, Shawen S, Lohnes J, Levy A, and Garrett W. Local Anesthesia in Outpatient Knee Arthroscopy: A Comparison of Efficacy and Cost. Arthroscopy: The Journal of Arthroscopic and Related Surgery;1996; 12: 482-488.