A comparison of local intraarticular anesthesia versus general anesthesia for ambulatory arthroscopic knee surgery

Various anesthetic techniques including local, regional, and general anesthesia have been utilized for ambulatory arthroscopic knee surgery. The choice of anesthetic technique for this surgical procedure can have a significant impact on postoperative recovery, side effects, and patient satisfaction. The objective of this randomized, prospective study is to evaluate the efficacy of utilizing either intraarticular (IA) local anesthesia or general anesthesia (GA) for patients undergoing outpatient arthroscopic knee surgery. Patients assigned to the local anesthesia group were administered an IA injection of 30 mL of bupivacaine 0.25% approximately 20-30 min before surgery. Intraoperative sedation was provided with the administration of propofol. Patients assigned to the GA group were administered propofol and fentanyl for induction and maintained with sevoflurane combined with nitrous oxide in oxygen by laryngeal mask airway. The surgeon injected 30 mL of bupivacaine 0.25% through the arthroscope at the completion of the surgical procedure. This study demonstrates that IA anesthesia provides for improved pain relief, decreased postoperative opioid use, postoperative nausea and vomiting (PONV), time spent in the recovery room, and improved patient satisfaction with similar operating conditions comparable to general anesthesia in patients undergoing outpatient arthroscopic knee surgery. Although both groups received a similar dose of IA bupivacaine, administering the local anesthetic prior to surgery resulted in more effective analgesia. We currently believe that intraarticular local anesthesia fulfills all the criteria for the optimal anesthetic technique for outpatient arthroscopic knee surgery.