Anesthesia For Knee Arthroscopy Research Articles

Anesthesia for knee arthroscopy: which nerves should be blocked?

Nowadays knee arthroscopy is the most common orthopedic procedure. It is used to diagnose and treat various pathological conditions. Usually knee arthroscopy can be performed using spinal anesthesia. The article presents a successful experience of using a combined technique, which consist in a unilateral subarachnoid anesthesia with additional adductor canal block and blocks of the articular branches of the sciatic and obturator nerves.

Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons\u2019 expertise: a survey among polish arthroscopy society members

BackgroundMeniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists.MethodsA total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.ResultsThe most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1–2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p = 0.007) and were more likely to use objective physical tests (p = 0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p = 0.001) and admitted that patient age does matter for meniscus repair qualification (p = 0.002).ConclusionsThere is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

Different routes of co-administration of magnesium sulphate with spinal anesthesia in knee arthroscopy: Randomized controlled trial

BackgroundAdequate pain management has a great importance for smooth postoperative recovery, early hospital discharge and early rehabilitation. In this study is we compare between the analgesic effect and possible side effects of different routs of magnesium sulphate administration in cases of spinal anesthesia for knee arthroscopy.Methods120 patients scheduled for knee arthroscopy 4 groups (30 patients each): group C received only Bupivacaine intrathecally. group Mg-Sp received 50 mg Mg sulphate with Bupivacaine intrathecally, group Mg-Iv 10 min after intrathecal injection, received intravenous injection of 30 mg/kg Mg sulphate in 100 ml saline over 10 min followed by 10 mg/kg intravenous infusion over one hour and group Mg-Art received intra-articular injection of 800 mg Mg sulphate diluted in 12 ml normal saline (0.9% NaCl) 10 min before the end of surgery. Operative time in minutes, VAS at rest and at passive movement, time to be able to perform knee flexion, time from end of surgery until first requirement of analgesics, analgesic consumption, hemodynamic changes and any possible side effects were recorded.ResultsRegarding Time to be able to perform knee flexion, time taken from end of surgery until first analgesic dose and amount of pethidine consumption in first postoperative 24 h, group Mg-Art is significantly better than other groups (P = 0.000) (P = 0.000) (P = 0.000) respectivly. Group Mg-Iv is significantly better than group Mg-Sp and group C as regards time taken from end of surgery until first analgesic dose (P = 0.000) and as regards amount of pethidine consumption in first postoperative 24 h (P = 0.000). VAS at rest and with passive movement in group Mg-Art is significantly lower other groups (P = 0.000).ConclusionIntraarticular administration of magnesium sulphate is found to be better than Intravenous magnesium and intrathecal in postoperative analgesia.

Local anesthesia and sedation vs. spinal anesthesia for knee arthroscopy

Abstract Objective To evaluate the efficacy of local anesthesia and diagnostic or therapeutic Arthroscopy procedures and compare them with spinal anesthesia. Material and methods We conducted a longitudinal, prospective, non-blind and analyst comparative clinical trial with two groups of 54 patients, aged 18–65 years. In the group assigned to local anesthesia and sedation, fentanyl, midazolam and propofol infusions were administered at the beginning of the surgery, the surgeon infiltrated ports and articular cavities with lidocaine and bupivacaine to provide postoperative analgesia. In the spinal anesthesia group, 7.5 mg of simple bupivacaine was injected into the cerebro-spinal fluid (CSF). Clinical indicators were evaluated and were contrasted using inferential statistics. Results There was a significant difference in the following variables: time from the patient's entry to the beginning of the surgery (Local 39.19 min SBA 55. 56 min,), the group treated with SBA showing a statistically greater value ( p 0.01), and length of stay in the recovery area (Local 102.33 min SBA 143 min), with the SBA group having the longest time ( p 0.01). Conclusions Values were observed to be significantly lower in the time from the anesthetic procedure until the beginning of the surgery and the time of discharge from the recovery in the group treated with local anesthesia and sedation technique, with a maximum value of EVA 3. In conclusion, this technique is a good choice for this type of procedure, having a lesser total duration for the procedure and recovery.

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy

AimTo evaluate efficiency of dexmedetomidine compared to fentanyl as supplements to low-dose levobupivacaine spinal anesthesia in patients undergoing knee arthroscopy.Materials and methodsSixty adult patients (ASA I or II) scheduled for knee arthroscopy were randomized to receive plain levobupivacaine (4 mg) plus dexmedetomidine (3 μg) in group D or fentanyl (10 μg) in group F.ResultsDexmedetomidine shortened time to surgery (P = 0.002), time to highest sensory level (P = 0.001), and time to highest Bromage score (P < 0.001). The highest sensory level was comparable in both groups (P = 0.969), but the duration of sensory block was significantly longer in group D (P = 0.009). The highest Bromage score was 2 in both groups. This score was attained in significant higher number of patients in group D (P = 0.038) that showed better muscular relaxation (P = 0.035). At the end of surgery, a residual motor block (Bromage score 1) was observed in significant higher number of patients (P = 0.033) and time to ambulation was significantly longer in group D (P = 0.001). There was no difference in the number of patients bypassed post-anesthesia care unit (PACU) (P = 0.761) or time to hospital discharge (P = 0.357) between groups. The pain free period was more prolonged (P < 0.001), and the visual analog scale (VAS) for pain was lower at the 2nd, 4th, 6th, and 8th postoperative hours (P < 0.001, <0.001, 0.013, 0.030 respectively) in group D.ConclusionDexmedetomidine is a good alternative to fentanyl for supplementation of low-dose levobupivacaine spinal anesthesia for knee arthroscopy.

Regional intravenous anesthesia in knee arthroscopy

OBJECTIVE:The goal of the study was to investigate the regıonal ıntravenous anesthesıa procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain.MATERIAL/METHOD:Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted.The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters.RESULTS:The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer.CONCLUSION:Regıonal ıntravenous anesthesıa using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.

Effects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy

The aim of the study was to investigate the effects of adding intrathecal magnesium sulfate 50 mg to low-dose bupivacaine-fentanyl on the spread, duration, regression of spinal block, and postoperative analgesia in patients undergoing knee arthroscopy. This study was designed in a prospective, randomized, and double-blinded manner. Sixty American Society of Anesthesiologists (ASA) physical status I or II patients were randomly allocated to receive 50 mg magnesium sulfate (3 ml) or 3 ml of preservative-free 0.9% NaCl following 6 mg bupivacaine 0.5% plus 10 microg fentanyl intrathecally. Date were collected regarding the highest level of dermatomal sensory blockade, the time to reach this level from the time of injection of the spinal anesthetic, Bromage scale of motor blockade at the time of reaching maximum sensory level, time for regression of two segments in the maximum block height, time to L(2) regression, time to ambulation, and postoperative analgesic consumption. The addition of intrathecal magnesium (50 mg) to spinal anesthesia prolonged the time for regression of two segments in the maximum block height and time to L(2) regression, but did not affect maximum sensory level or the time to reach the highest level of sensory block. Even though the mean times to complete recovery of motor function were similar in the two groups, time to ambulation was significantly longer in the magnesium group than in the saline group. Total analgesic consumption in the first 24 h was not decreased significantly with the addition of magnesium to spinal anesthesia, but the time to first analgesic requirement was prolonged significantly. Even though the time to first analgesic requirement was prolonged significantly by magnesium, the addition of intrathecal magnesium sulfate to spinal anesthesia is not desirable in patients undergoing knee arthroscopy due to the prolonged time to ambulation and the lack of effect of magnesium on postoperative analgesic consumption.

Intravenous regional anesthesia for knee arthroscopy

Intravenous regional anesthesia for knee arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Ambulatory Anesthesia for Knee Arthroscopy

Combined Spinal-Epidural Anesthesia for Outpatient Surgery

Background : Combined spinal-epidural anesthesia (CSE) may offer theoretic advantages for outpatient surgery, because it produces the rapid onset of spinal anesthesia, with the option to extend the blockade with an epidural catheter. In this study, the authors attempted to determine an appropriate initial dose of a short-acting local anesthetic, 2% lidocaine, to administer for outpatient knee arthroscopy using CSE. Methods : Data were collected from 90 patients undergoing outpatient knee arthroscopy. Using a double-blinded, prospective study design, patients were randomly assigned to receive CSE with an initial dose of intrathecal 2% lidocaine of 40, 60, or 80 mg. A 27-G 4 11/16-inch Whitacre needle was placed through a 17-G Weiss needle. Onset and regression of sensory anesthesia and motor blockade were measured by a blinded observer at frequent intervals. Results : All 90 patients had adequate anesthesia. Durations of thoracic and lumbar sensory and lower limb motor blockade were significantly shorter in the 40-mg group compared with the 60- or 80-mg groups (P < 0.0002 Mantel-Cox, Survivorship Analysis). Indices of neural blockade resolved 30-40 min more rapidly in the 40-mg group than in either the 60- or 80-mg group. Times to urinate, sit upright in a chair, take oral fluids, and be discharged were all significantly shorter (between 30 and 60 min) in the 40-mg group compared with the 60- and 80-mg groups (P < 0.01). Seven patients required intraoperative epidural supplementation : three in the 40-mg group, three in the 60-mg group, and one in the 80-mg group. Conclusions : Combined spinal-epidural anesthesia with a 40-mg initial intrathecal dose of lidocaine provided reliable anesthesia for knee arthroscopy. Duration of spinal anesthesia with lidocaine was dose related.

EFFECT OF ADRENALINE ON PLASMA CONCENTRATIONS OF BUPIVACAINE FOLLOWING INTRA-ARTICULAR INJECTION OF BUPIVACAINE FOR KNEE ARTHROSCOPY

We administered 0.5% bupivacaine 30 ml either with or without adrenaline 5 micrograms ml-1 randomly to 16 healthy outpatients, to determine the efficacy of local and intra-articular local anaesthesia for knee arthroscopy and whether or not adrenaline should be added to intra-articular bupivacaine. Bupivacaine concentrations were measured in plasma obtained 15, 30, 45 and 60 min after intra-articular injection. Patients receiving bupivacaine with adrenaline had significantly smaller plasma concentrations of bupivacaine at all times than did patients receiving plain bupivacaine. The maximal concentrations of bupivacaine in the plain group (median 515 ng ml-1, range 46-875 ng ml-1) were greater than those in the adrenaline group (median 33 ng ml-1, range 7-125 ng ml-1) (P = 0.001). All patients found the anaesthetic satisfactory. We conclude that intra-articular/local anaesthesia is satisfactory for outpatient arthroscopic surgery, and that adrenaline should probably be added to bupivacaine before intra-articular injection.