Is knee arthroscopy under local anaesthetic a patient-friendly technique? A prospective controlled trial.
OBJECTIVE
To determine that when the patient chooses their intervention, whether there is any difference in duration of surgery, effectiveness, patient satisfaction and recovery time between two methods of anaesthesia, local anaesthetic (LA) and general anaesthesia (GA) in knee arthroscopy (KA).


METHODS
Inclusion criteria were medically fit, adults, undergoing unilateral KA, in a native knee as a day case. Exclusion criteria were requirement for ligament reconstruction or meniscal repair, pre-existing regional sensory impairment or active psychiatric condition. A prospective comparator controlled trial was conducted. The experimental group received local anaesthetic into the joint and no tourniquet. This was compared to a standard treatment, using GA with tourniquet. The LA group received 40 ml of anaesthetic consisting of 20 ml 0.5 % bupivacaine with adrenaline and 20 ml of 1 % lignocaine with adrenaline. Pre- and postoperative visual analogue score were completed, and patient's satisfaction was assessed using a scale of one to five. Operative and recovery time was recorded.


RESULTS
There was a significant decrease in recovery time for the LA group, 14 min 55 s, compared to 72 min 25 s (p = 0.004). Pain levels in the LA group were significantly decreased compared to the GA group. No failures of LA resulting in conversion to GA; no difference in patient satisfaction between the two groups 4.88/5 in the GA group and 4.81/5 in the LA group. 48 patients joined the LA group, and 34 patients joined the GA group. Both groups displayed similar demographic variables and underwent similar intraarticular interventions.


CONCLUSIONS
When patients undergoing KA choose their method of anaesthesia, LA is a reliable option. Use of LA results in decreased recovery time and postoperative pain, with similar levels of patient satisfaction when compared to GA.
Bendigo Orthopaedic and Sport Medicine Clinic, Bendigo, VIC, Australia. dr.sbarroso@gmail.com.|Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD , Australia. dr.sbarroso@gmail.com.
Sergio
S
Barroso Rosa
Bendigo Orthopaedic and Sport Medicine Clinic, Bendigo, VIC, Australia.
Dugal
D
James
Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD , Australia.
Brent David
BD
Matthews
D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D001315:Australia; D002045:Bupivacaine / Q000008:administration & dosage*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy; D017060:Patient Satisfaction; D011446:Prospective Studies; D013566:Sympathomimetics
D000779:Anesthetics, Local; D013566:Sympathomimetics; D008012:Lidocaine; D002045:Bupivacaine; D004837:Epinephrine
Arthoscopy; Controlled; Knee; Local anesthetic; Patient satisfaction; Prospective