2019, Number 6
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Acta Ortop Mex 2019; 33 (6)
Effectiveness of intra-articular anesthesia in knee arthroscopy
Martínez-Navarro JL, Espinoza-Castolo M, Vargas-Vargas SF
Language: Spanish
References: 10
Page: 365-369
PDF size: 164.59 Kb.
ABSTRACT
Indroduction: Knee arthroscopy is one of the most commonly performed procedures. General anesthesia and spinal blockage are the most common forms of anesthesia. We consider that this surgery can be managed with intra-articular local anesthesia, thus avoiding prolonged stays in recovery, with effective pain management and optimization of presurgical, intrasurgical and post-surgical times.
Material and methods: Prospective, quasi-experimental, longitudinal study to compare two anesthetic procedures: intraarticular anesthesia (lidocaine with epinephrine, bupivacaine and fentanyl) without the use of ischemia (group A); spinal blockage and use of ischemia (group B) by assessing age, surgery time, pain during surgery and 24 hour post-op VA scale, time spent in recovery, need to administer general anesthesia or anesthetic rescue doses, 24-hour range of motion. Student t-test, significance level was used: p ‹ 0.05 for nonparametric variables and χ
2 parametric variables.
Results: 38 patients were included per group. The surgical time (45 min vs 39 min, p = 0.03), recovery time (1.9 vs 3 hours, p = 0.0004) were lower in group A, while pain during surgery was greater (17 vs 3%, p = 0.09), without requiring general anesthesia.
Conclusion: The advantages in favor of intraarticular anesthesia were: shortened hospital stays, less pain at 24 hours, safety in its application. Its disadvantage is the possibility of pain during surgery and sedation is sufficient as adjuvant.
REFERENCES
Johnson D, Amendola N, Barber F. Operative arthroscopy. Philadelphia: Wolters Kluwer; 2015.
Shaukat Y, Malik E, El-Khateeb H, Koeweiden E. The role of local anaesthesia in knee arthroscopy. J Orthop. 2013; 10(4): 193-5. Disponible en: http://dx.doi.org/10.1016/j.jor.2013.06.003.
Zhou Y, Yang T Bao, Wei J, Zeng C, Li H, Yang T, et al. Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis. Knee Surgery, Sport Traumatol Arthrosc. 2016; 24(5): 1651-9.
Yang Y, Zeng C, Wei J, Li H, Yang T, Deng Z, et al. Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2017; 25(3): 966-79.
Mondino JA. Artroscopia de rodilla con anestesia local. Artroscopia. 2006; 13(2): 102-10
De Santiago J, Santos-Yglesias J, Giron J, Jimenez A, Errando CL. Low-dose, low-concentration levobupivacaine plus fentanyl selective spinal anesthesia for knee arthroscopy: a dose finding study. Anesth Analg. 2011; 112(2): 477-80.
Bech NH, Hulst AH, Spuijbroek JA, Leuken LLA Van, Haverkamp D. Perioperative pain management in hip arthroscopy; what options are there? J Hip Preserv Surg. 2016; 3(3): 181-9.
Trejo MR, Valdés LM, Roldán FT. Artroscopía de la rodilla bajo anestesia local. Rev Mex Ortop Traum. 2000; 14(2): 191-5.
Rodríguez VA, Anguiano GM. Anestesia intra-articular en la artroscopía de la rodilla. Estudio experimental comparativo doble ciego. Rev Mex Ortop Traum. 2000; 14(192): 196-9.
Díaz-Osuna V, Vilchez-Cavazos F, Palacios-Ríos D, Ibarra-Malacara EA, Espinosa-Galindo AM. Local anesthesia and sedation vs. spinal anesthesia for knee arthroscopy. Med Univ. 2016; 18(72): 153-7. Disponible en: http://www.sciencedirect.com/science/article/pii/S1665579616300850.