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Minerva Anestesiologica 2000 March;66(3):131-6


language: English

Unilateral spinal anesthesia or combined sciatic-femoral nerve block for day-case knee arthroscopy

Cappelleri G., Casati A., Fanelli G., Borghi B., Anelati D., Berti M., Albertin A.; Commento: Savoia G.

From the Department of Anesthesiology University of Study - Milano IRCCS H. San Raffaele - Milano *Department of Anesthesiology IRCCS Rizzoli Orthopedic Institute - Bologna


Background. To eval­u­ate the ­time ­required to ­achieve sur­gi­cal ­block and ful­fill stan­dard­ized dis­charg­e cri­te­ria in out­pa­tients receiv­ing ­knee arthros­co­py ­with ­either uni­lat­er­al spi­nal anes­the­sia or com­bined sciat­ic-femo­ral ­nerve ­block.
Methods. After a stan­dard mid­az­o­lam/keto­prof­en pre­med­i­ca­tion and base­line meas­ure­ment of car­di­o­vas­cu­lar param­e­ters, 50 ASA phys­i­cal stat­us I-II ­patients sched­uled for elec­tive out­pa­tient ­knee arthros­co­py ­were ran­dom­ized to ­receive uni­lat­er­al spi­nal anes­the­sia ­with 8 mg of 0.5% hyper­bar­ic bupiv­a­caine inject­ed with­out bar­bot­age ­through a 25-­gauge Whitacre spi­nal nee­dle (­group USA, n=25), or com­bined sciat­ic-femo­ral ­nerve ­block ­with 25 ml of 2% mepiv­a­caine (15 ml for femo­ral ­nerve ­block and 10 ml for sciat­ic ­nerve ­block) (­group ­SFNB, n=25). Times ­from ­local anes­thet­ic injec­tion to achieve­ment of sur­gi­cal ­block ­defined as the pres­ence of ade­quate ­motor (com­plete ­motor block­ade of the oper­at­ed ­limb in the USA ­group and inabil­ity to ­move the ­ankle and the ­knee of the oper­at­ed ­limb in the ­SFNB ­group) and sen­so­ry (­loss of pin­prick sen­sa­tion at T12 on the oper­at­ed ­side in the USA ­group, or in the femo­ral and sciat­ic ­nerves dis­tri­bu­tion in the ­SFNB ­group) ­blocks was record­ed. Times to ­block res­o­lu­tion, uri­na­tion, unas­sist­ed ambu­la­tion, and readi­ness to ­home dis­charge ­were ­also record­ed by a ­blind observ­er, as ­well as occur­rence of unto­ward ­events dur­ing sur­gery.
Results. Surgical ­block was ­achieved in 15±6 min in ­group USA and 16±6 min in ­group ­SFNB (p=NS). No dif­fer­enc­es in hemo­dy­nam­ic unde­sired ­effects and suc­cess ­rate ­were ­observed. Even ­though USA ­patients ­showed a fas­ter ­time to ambu­la­tion (166±44 min ver­sus 217±49 min, p=0.002) and lat­er uri­na­tion (240±90 min ver­sus 145±36 min, p=0.0001) ­than ­SFNB ­group, no dif­fer­enc­es in ­home dis­charg­ing ­were report­ed (246±98 min ver­sus 211±77 min, respec­tive­ly). Bladder cath­et­er­iza­tion was ­required in 2 ­patients of USA ­group ­only; how­ev­er, no ­patient was admit­ted to the hos­pi­tal ­because of uri­nary reten­tion.
Conclusions. In out­pa­tient ­knee arthros­co­py, a com­bined sciat­ic-femo­ral ­nerve ­block ­with 2% mepiv­a­caine pro­vides sim­i­lar­ly suc­cess­ful anes­the­sia ­with ­onset ­times and ­home dis­charg sim­i­lar to ­those pro­vid­ed by uni­lat­er­al spi­nal anes­the­sia.

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