Outpatient Arthroscopic Knee Surgery Research Articles

Safety and Satisfaction of Outpatient Versus Inpatient Care for Arthroscopic Knee Surgery in Thailand

Background: Although outpatient surgery volume has rapidly grown in the western counties. However, the rate of growth for outpatient surgery has been slow in Thailand. There are limited studies comparing outcomes and cost analysis in outpatient arthroscopic knee surgery in Thailand. Objective: To compare the 24-hour postoperative pain score, side-effects and the total cost associated between inpatient and outpatient care following arthroscopic knee surgery. Materials and Methods: A retrospective cohort study of 42 patients undergoing elective arthroscopic knee surgery under general anesthesia and receiving ultrasound guided adductor canal block for post-operative analgesia. The two cohorts were matched with a 1:1 ratio for age, sex, body mass index, type of surgery and operation time. The primary outcome was the 24-hour postoperative pain score. Secondary outcomes included: the incidence of inadequate analgesia, adverse events, cost associated with outpatient versus inpatient care, and patient satisfaction score. Results: The 24-hour postoperative pain score was median 2 (IQR 0, 3) versus 2 (IQR 1, 3) in the outpatient and inpatient groups, respectively. No major complications, reoperation, or readmission after surgery was seen in either group. The total hospital cost between outpatient versus inpatient showed not significant difference (1,871.09±555.53 USD versus 1,966.49±549.70 USD, p=0.58). The costs related to perioperative service, inpatient surgery ward service, and room and food service were significantly different. Satisfaction score was comparable between groups. Conclusion: In Thailand, outpatient arthroscopic knee surgery provided the same 24-hour postoperative pain control scores and clinical outcomes when compared to inpatient setting. There was no significant difference in total hospital cost between outpatient and inpatient care. However, costs related to perioperative period (e.g., inpatient room and food service) were significantly different. Keywords: Ambulatory surgery; Arthroscopic knee surgery; Adductor canal block; Safety and satisfaction; Medical cost

Comparison of hemodynamics, recovery profile and postoperative analgesia of unilateral spinal anaesthesia with combined sciatic-femoral nerve block in knee arthroscopy

In this randomized, controlled, blind study, a combined sciatic-femoral nerve block with levobupivacaine was compared with a unilateral spinal anaesthesia with respect to effectiveness, patient and surgeon satisfaction, and the effect on postoperative pain in arthroscopic knee surgery. Patients were randomly divided into two groups. Group I (n=20) received a combined sciatic-femoral nerve block with levobupivacaine 0.5% totalling 40 ml. In group II (n=20), a spinal anaesthesia in the lateral decubitus position (ULSA) with 7.5 mg levobupivacaine 0.5% was performed, and patients were kept in the same position to achieve an anaesthesia level of T12 (maximum 10 minutes). The development of motor and sensorial block on both sides and onset time to surgical anaesthesia were recorded. The time required for the postoperative recovery score to be ≥12 was recorded. In the postoperative period, postoperative analgesia (VAS), motor block, side effects, and patient and surgeon satisfaction were recorded at the 1st, 3rd, 6th and 12th hours. Time of readiness for surgery was significantly shorter in Group II (p<0.05). All patients were satisfied with both techniques. There were no differences in judgement between the groups. VAS scores at the 6th hour were significantly lower in group I than in group II (p<0.05). Combined sciatic-femoral nerve block for outpatient arthroscopic knee surgery offers satisfactory anaesthesia, with a clinical profile similar to that of low-dose spinal anesthesia. Sciatic-femoral nerve blocks are associated with significantly lower pain scores during the first 6 postoperative hours.

Comparison of a Pain Pump versus Injectable Medication for Analgesia in Knee Arthroscopy

As arthroscopic knee procedures have evolved, so has the management of post-operative pain. Traditional pain management included intravenous narcotics, which often resulted in nausea and increased sedation. In an effort to reduce post-operative pain and minimize complications, the concept of multimodal analgesia evolved, including subcutaneous infiltration of local anesthetic, ketorolac and/or narcotic. We studied the effect upon post-operative pain of combining ropivacaine, ketorolac and morphine injected as a one-time dose compared to the same mixture plus an intraarticular pump administering ropivacaine for 24 hours. Our findings showed that a single subcutaneous and intraarticular injection of ketorolac, morphine and ropivacaine was as effective as this solution plus a 24-hour intraarticular ropivacaine pain pump for post-operative pain relief after outpatient arthroscopic knee surgery. No clinical or radiographic signs of chondrolysis were seen in the knee with the use of intraarticular ropivacaine at an average of 18 months post-operatively.

A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia

Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia.

Comparison of spinal anesthesia with combined sciatic-femoral nerve block for outpatient knee arthroscopy

Study Objective To compare spinal anesthesia and combined sciatic-femoral nerve block for outpatient knee arthroscopy. Design Prospective, randomized, controlled study. Setting Postoperative recovery area at a university-affiliated medical center. Patients 50 ASA physical status I and II adult outpatients undergoing arthroscopic knee surgery. Interventions Study subjects were equally divided (n = 25 each) into spinal and sciatic-femoral groups. Spinal group patients received spinal anesthesia with 7.5 mg of 0.5% hyperbaric bupivacaine. Sciatic-femoral group patients received combined sciatic-femoral nerve blocks using a mixture of 20 mL of lidocaine 2% plus 20 mL of bupivacaine 0.5%. Measurements Times including that from arrival in the operating room to readiness for surgery, duration of surgery, recovery time, and patient satisfaction were recorded. Analgesia and occurrence of adverse events also were recorded. Main Results No significant differences between the two groups were found for any of the study measurements of recovery. After discharge, postoperative pain differed significantly between groups only at 6 hours ( P < 0.002). Patient satisfaction was high with both techniques. Conclusions Combined sciatic-femoral nerve block for outpatient arthroscopic knee surgery offers satisfactory anesthesia, with a clinical profile similar to that of low-dose spinal anesthesia. Sciatic-femoral nerve blocks are associated with significantly lower pain scores during the first 6 postoperative hours.

Ultrasound-guided infrapatellar nerve block in human volunteers: description of a novel technique

Despite the use of various treatment strategies arthroscopic knee surgery is still associated with clinically important postoperative pain. As the infrapatellar nerve (IPN) innervates vital anterior knee structures we decided to investigate the feasibility of a novel ultrasound-guided IPN block technique as a potential therapeutic option for out-patient arthroscopic knee surgery. The IPN was blocked under ultrasonographic guidance in 10 adult volunteers using 5 ml of levobupivacaine 5 mg ml(-1). Success rate, time to maximum cutaneous distribution of the block, distribution of cutaneous analgesia and time until full recovery of cutaneous sensation was noted as was the incidence of concomitant blockade of the saphenous nerve (SN). The IPN was successfully blocked in 9/10 subjects. However, a varying degree of concomitant SN block was observed as part of all blocks. The time to maximum cutaneous distribution of the block was 8.4 (sd 3.6) min and the duration until complete recovery of cutaneous sensation was 27.5 (19.1) h. Reliable blockade of the IPN can be achieved with ultrasonographic guidance. Because of the very close anatomical relationship between the IPN and the SN it appears inevitable to also get a variable degree of concomitant SN block. The duration of the IPN block was in the majority of subjects greater than 16 h, a finding that may make this block useful for postoperative analgesia in out-patient arthroscopic surgery.

Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery

Study ObjectiveTo compare the effects of intrathecal ropivacaine with bupivacaine in a dose ratio of 2:1 for outpatient arthroscopic knee surgery. DesignRandomized, single-blinded study. SettingUniversity-affiliated hospital. Patients90 patients scheduled for outpatient arthroscopic knee surgery. InterventionsPatients were randomized and assigned in single-blinded fashion to receive a 3-mL solution of either 15 mg of isobaric ropivacaine (group R; n = 45) or 7.5 mg of isobaric bupivacaine (group B; n = 45) through a 27-gauge Quincke spinal needle at the L3 to L4 interspace, while placed in the lateral decubitus position. MeasurementsOnset and offset times for sensory and motor block; highest level of sensory block; duration of the sensory and motor block; first ambulation, urination, and discharge time; mean arterial pressure; and heart rate were all recorded. Main ResultsOnset time for sensory block (mean ± SD) to L1 and time until sensory block regressed to L2 were shorter in group R. Complete motor block occurred in 40 patients with ropivacaine and 45 patients with bupivacaine. First ambulation and first urination and discharge times were similar between the two groups. Cephalad spread of sensory block was higher with ropivacaine (P < 0.05). The median (range) upper sensory level obtained with bupivacaine was T11 (T6-L1) and T8 (T6-T10) with ropivacaine. Hemodynamic changes were similar between the groups (P > 0.05). ConclusionIsobaric ropivacaine 15 mg provided a higher sensory block level and shorter sensorial onset and offset times than did 7.5 mg of isobaric bupivacaine.

Outpatient Arthroscopic Knee Surgery Under Multimodal Analgesic Regimens

To investigate whether diclofenac could be used in preemptive and multimodal fashion with local anesthesia (LA) during arthroscopic knee surgery. A cohort of 628 patients (age range, 14 to 60 years) underwent outpatient arthroscopic knee surgery under LA with 15 mL of 2% lidocaine with epinephrine. Diclofenac 1 mg/kg was administered immediately before the procedure was performed. Pain was intraoperatively assessed with a 10-cm visual analogue scale (VAS). Patients' and surgeons' satisfaction with the quality of anesthesia was estimated by a special questionnaire and VAS score. From the technical point of view, arthroscopic procedures were successfully completed in 98.2% of patients. Pain experienced during injection of lidocaine (VAS score: median, 2.9; mean, 3.4; standard deviation [SD], 3.2; range, 0 to 10) was more severe (P = .0001) than pain experienced during the surgical procedure itself (VAS score: median, 1.8; mean, 2.4; SD, 2.2; range, 0 to 5.2). Arthroscopy was well tolerated by most patients (98.5%), and only 1.4% of procedures had to be terminated prematurely because of patient discomfort. Almost 95.7% of patients reported that they would undergo the same procedure again under the same type of anesthesia. In 4.7% of patients, LA was not considered optimal by the performing surgeon. Arthroscopic knee surgery with diclofenac and LA with no premedication is an efficient and well-tolerated method used in outpatient practice with no major adverse effects. Level IV, therapeutic case series.

Outpatient arthroscopic knee surgery under combined local and intravenous propofol anesthesia in children and adolescents

This prospective observational study included a case series of children and adolescents receiving light intravenous propofol anesthesia combined with local anesthesia (LA) for arthroscopic knee procedures. The aim was to examine the merits of anesthesia, to discuss the indications for the procedure and to analyze recovery/discharge times from the postanesthesia care unit (PACU). A cohort of 147 children and adolescents (ASA 1 and 2) aged 12-18 years admitted for outpatient arthroscopic knee procedures between January 2004 and May 2005 were studied. After IV access in the operating theater, the patients received propofol (10 mg.ml(-1)). Arthroscopy was performed approximately 15 min after injecting local anesthetic (15 ml 2% lidocaine with epinephrine 1:200,000) partly at the site of insertion of the arthroscope and other instruments (5 ml), and the rest intra-articular. The following parameters were assessed: airway patency, propofol requirement, vital signs, procedure time, surgical operating conditions, patient satisfaction score, time to discharge, postoperative analgesia and adverse events. Of 147 patients, 133 patients (90.5%) underwent arthroscopic knee surgery, whereas knee arthroscopy alone was performed in 14 patients (9.5%) without indication for operative treatment. The arthroscopy was well tolerated in 96.6% patients (no pain, movement or discomfort during the procedure) and only five patients required conversion to general anesthesia. Pain experienced during the injection of lidocaine was more severe than pain experienced during the surgical procedure itself (P < 0.001). The surgical evaluation of operative conditions (visualization and access to intra-articular structures) was generally satisfactory and completely acceptable. Almost 94% (138/147) of patients said they would have the same procedure again under the same type of anesthesia. The mean propfol induction dose was 1.4 mg.kg(-1) (range: 0.9-3.8) and mean propofol infusion rate 167 microg.kg(-1).min(-1) (range: 130-250). Movement was more likely at lower infusion rates (mean: 151 microg.kg(-1).min(-1)). The maximal decrease in respiratory rate was 5.9 +/- 5.1 br.min(-1) (27.2 +/- 21%) and no patient became hypoxic. Patients recovered to preoperative values at 9.8 +/- 7.5 min following infusion discontinuation. There were no respiratory or cardiovascular complications. The mean stay in PACU was 47 min (range: 32-150). As many as 71% (105/147) of patients required no analgesics during the first two postoperative hours. The combination of light intravenous propofol anesthesia combined with local anesthesia for arthroscopic knee procedures provided effective sedation, good preservation of upper airway patency, rapid recovery and pain relief without major side effects and offers a good alternative to the methods already available. The majority of patients did not require postoperative analgesia.

A comparison of local intraarticular anesthesia versus general anesthesia for ambulatory arthroscopic knee surgery

Various anesthetic techniques including local, regional, and general anesthesia have been utilized for ambulatory arthroscopic knee surgery. The choice of anesthetic technique for this surgical procedure can have a significant impact on postoperative recovery, side effects, and patient satisfaction. The objective of this randomized, prospective study is to evaluate the efficacy of utilizing either intraarticular (IA) local anesthesia or general anesthesia (GA) for patients undergoing outpatient arthroscopic knee surgery. Patients assigned to the local anesthesia group were administered an IA injection of 30 mL of bupivacaine 0.25% approximately 20–30 min before surgery. Intraoperative sedation was provided with the administration of propofol. Patients assigned to the GA group were administered propofol and fentanyl for induction and maintained with sevoflurane combined with nitrous oxide in oxygen by laryngeal mask airway. The surgeon injected 30 mL of bupivacaine 0.25% through the arthroscope at the completion of the surgical procedure. This study demonstrates that IA anesthesia provides for improved pain relief, decreased postoperative opioid use, postoperative nausea and vomiting (PONV), time spent in the recovery room, and improved patient satisfaction with similar operating conditions comparable to general anesthesia in patients undergoing outpatient arthroscopic knee surgery. Although both groups received a similar dose of IA bupivacaine, administering the local anesthetic prior to surgery resulted in more effective analgesia. We currently believe that intraarticular local anesthesia fulfills all the criteria for the optimal anesthetic technique for outpatient arthroscopic knee surgery.

Simultaneous live video presentation during knee arthroscopy

AbstractTo improve patient understanding, we evaluated prospectively the effect of patient-observed simultaneous surgeon-explained live video during knee arthroscopy. Patient satisfaction, understanding, and tolerance of the tenderness and pain were measured by a questionnaire completed immediately after the procedure. There were 72 patients (41 men, 31 women) with a mean age of 47 years; 76 joints were treated among them. All but one were comfortably able to watch the live video of the procedure, and 89% of the patients reported a good understanding of and satisfaction with the procedure. Moreover, if the patients ever had to have another arthroscopy, 66% answered that they “certainly” wanted a live video presentation, and 25% “somewhat” desired it. Live video-presented outpatient arthroscopic knee surgery could be considered a method for improving patient understanding of knee pathology.

Lidocaine hydrochloride versus lidocaine bicarbonate for epidural anesthesia in outpatients undergoing arthroscopic surgery

In a randomized, double-blind .study, 24 patients undergoing outpatient arthroscopic knee surgery were divided into two groups. Group 1 received 2% lidocaine hydrochloride; group 2 received pH-adjusted 1.73% lidocaine made by adding 1 ml of NaHCO 3 44.6 meg/L to 10 ml of 2% lidocaine hydrochloride. Epidural anesthesia was administered in the sitting position. Group 1 consisted of 12 males; group 2 consisted o J 6 males and 6 females ( p < 0.01). Statistical analysis using the unpaired Student's t-test and the Mann-Whitney test found no significant differences between the two groups regarding time o J onset o J analgesia, degree of spread of analgesia, time to maximum motor blockade, degree of motor blockade, length of surgical procedure, total anesthesia time, regression of anesthesia, dosage of lidocaine used, and serum lidocaine levels. Intraoperative conditions were satisfactory in all cases. Postoperatively, all patients reported having experienced a satisfactory anesthetic without any complications. The authors conclude that epidural anesthesia is a satisfactory technique for outpatient arthroscopic surgery. There appears to be no advantage to adding bicarbonate to lidocaine anesthetic solutions for use in epidural anesthesia.