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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 June;70(6):493-502


language: English, Italian

Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy

Casati A. 1, Cappelleri G. 1, Aldegheri G. 1, Marchetti C. 1, Messina M. 1, De Ponti A. 2

1 Department of Anesthesiology IRCCS San Raffaele Hospital Vita et Salute University, Milan, Italy 2 Department of Orthopedic Surgery IRCCS San Raffaele Hospital Vita et Salute University, Milan, Italy


Aim. The aim of ­this ­study was to com­pare effi­ca­cy, effi­cien­cy and ­surgeon's sat­is­fac­tion of ­total intra­ve­nous anes­the­sia ­with pro­pof­ol and remi­fen­ta­nil ­with ­those of spi­nal or periph­er­al ­nerve ­blocks for out­pa­tient ­knee arthr­so­copy.
Methods. One hun­dred and twen­ty ­patients under­go­ing elec­tive out­pa­tient ­knee arthros­co­py ­were ran­dom­ly allo­cat­ed to ­receive ­total intra­ve­nous anes­the­sia ­with pro­pof­ol and remi­fen­ta­nil (40), com­bined sciat­ic-femo­ral ­nerve ­block (40), or spi­nal anes­the­sia (40). Prepara-­tion ­times, ­surgeon’s sat­is­fac­tion, and dis­charge ­times ­with the 3 anes­the­sia tech­niques ­were meas­ured. Anesthesia-relat­ed ­costs ­were ­also com­pared ­based on ­costs of ­drugs, dis­pos­able mate­ri­als, and anes­the­sia and ­nurse ­staff.
Results. Preparation ­time was 13 min (8-22 min) ­with gen­er­al anes­the­sia, 15 min (5-30 min) ­with spi­nal anes­the­sia and 15 min (5-25 min) ­with sciat­ic-femo­ral ­blocks (p=0.006). Surgeon’s sat­is­fac­tion was sim­i­lar in the 3 ­groups, but 17 ­patients receiv­ing periph­er­al ­nerve ­block (42%) and 12 receiv­ing spi­nal anes­the­sia (30%) by-­passed the post­an­es­the­sia ­care ­unit ­after sur­gery as com­pared ­with ­only 2 gen­er­al anes­the­sia ­patients (5%) (p=0.01). Discharge ­from the post­an­es­the­sia ­care ­unit ­required 5 min (5-20 min) ­after periph­er­al ­block as com­pared ­with 15 min (5-25 min) ­with spi­nal and 15 min (5-80 min) ­with gen­er­al anes­the­sia (p=0.005); how­ev­er, ­stay in the Day-Surgery Unit was short­er ­after gen­er­al anes­the­sia [170 (100-400) min] ­than periph­er­al [265 (110-485) min] or spi­nal ­blocks [230 (95-800) min] (p=0.026). Urinary reten­tion was report­ed in 3 spi­nal ­patients ­only (8%) (p=0.03).
Conclusion. Regional anes­the­sia tech­niques ­reduce the ­rate of admis­sion and the dura­tion of ­stay in the post­an­es­the­sia ­care ­unit as com­pared ­with gen­er­al anes­the­sia. Peripheral rath­er ­than spi­nal ­nerve ­blocks ­should be pre­ferred to min­i­mise the ­risk for uri­nary reten­tion.

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