title: Outpatient arthroscopic knee surgery under multimodal analgesic regimens.
abstract: OBJECTIVE
  To investigate whether diclofenac could be used in preemptive and multimodal fashion with local anesthesia (LA) during arthroscopic knee surgery.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedics, Sveti Duh General Hospital, Zagreb, Croatia.
authors.forename: Mladen
authors.initials: M
authors.lastname: Miskulin
authors.forename: Branka
authors.initials: B
authors.lastname: Maldini
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy / Q000379:methods; D004008:Diclofenac / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010045:Outpatients; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D004008:Diclofenac; D008012:Lidocaine