Abstract
Purpose: We compared the recovery profiles, postoperative complications, perioperative OR utilization times, and times to discharge of patients undergoing ambulatory knee arthroscopy under spinal anesthesia (SA) or general anesthesia (GA).
Methods: In this randomized, propsective study, 84 ASA I–II patients were randomized to receive either SA with 50 mg of 1% lidocaine, or a standardized GA. Postoperative pain, nausea and vomiting, sedation, OR utilization, postanesthesia care unit (PACU), and ambulatory surgical unit (ASU) recovery were compared.
Results: Patients in the GA group had more pain in the PACU than the SA group (61%vs 15%,P<0.01), and a higher incidence of PACU analgesic use (59%vs 7.5%,P <0.01). Patients in the SA group were able to drink and eat sooner than the GA group (83± 23vs 95±22 min,P <0.05 and 88±27vs 105±29 min,P <0.01, respectively). The times to sit, walk, and void were similar. The length of PACU and ASU stay between the GA and SA groups were similar (67±17vs 60±19 min,P >0.05 and 122±27vs 127.9±31 min,P>0.05, respectively). The incidence of backache was higher in the SA group (35vs 3.6%,P <0.05) than the GA group. However, the incidence of sore throat was higher in the GA compared to the SA group (25%vs 2.5%,P <0.01).
Conclusions: SA with 50 mg of 1% lidocaine provides an improved recovery profile for ambulatory knee arthroscopy. Discharge times were similar, and with the exception of backache and sore throat, the incidence of complications was similar.
Résumé
Objectif: Comparer les profils de récupération, les complications postopératoires, les temps d’utilisation périopératoire de la salle d’opération et le temps de séjour des patients ui subissent une arthroscopie du genou sous rachianesthésie (RA) ou anesthésie générale (AG).
Méthode: L’étude randomisée et prospective a porté sur 84 patient, d’état physique ASA I’II, qui ont reçu au hasard soit une RA avec 50 mg de lidocaïne à 1 %, soit une AG standard. La douleur postopératoire, les nausées et vomissements, la sédation, l7rsutilisation de la salle d’opération, la récupération en salle de réveil et à l’unité de chirurgie ambulatoire (UCA) ont été comparés.
Résultats: Les patients du groupe d’AG ont ressenti plus de douleurs à la salle de réveil que ceux du groupe de RA (61 % vs 15 %, P<0,01) et y ont utilisé davantage d’analgésie postopératoire (59 % vs 7,5 %, P<0.01). Les patients du group RA ont pu boire et manger plus tôt que ceux du groupe d’Ag (83±83 vs 95±22 min, P<0,05 et 88±27 vs 105±29 min, P<0,01, respectivement). Le temps éculé avant de pouvoir s’asseoir, marcher et avant la première miction a été similaire pour tous. Le séjour en salle de réveil et à l’UCA a été d’une durée similaire pour les patients des groupes AG et RA (67±17 vs 60±19 min, P>0,05 et 122±27 vs 127,9±31 min, P<0,05, respectivement). L’incidence de maux de dos a été plus élevée dans le groups RA (35 vs 13,6 %, P<0,05) que dans le groupe AG. Cependant, l’incidence de maux de gorge a été plus grande dans le groupe d’AG que dans le groupe RA (25 % vs 2,5 %, P<0,01).
Conclusion: La RA réalisée avec 50 mg de lidocaïne à 1 % en chirurgie ambulatoire fournit un meilleur profil de récupération d’une arthroscopie du genou que l’AG. Mis à part les maux de dos et de gorge, le temps écoulé avant le congé et l’incidence des complications ont été similaires.
Article PDF
Similar content being viewed by others
References
Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment and prevention. Anesthesiology 1992; 77: 162–84.
Dahl JB, Schultz P, Anker-Møller E, Christensen EF, Staunstrup HG, Carlsson P. Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia. Br J Anaesth 1990; 64: 178–82.
Chung F. Recovery pattern and home-readiness after abmulatory surgery. Anesth Analg 1995; 80: 896–902.
Standl T, Eckert S, Schulte J. Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery. Acta Anaesthesiol Scand 1996; 40: 222–6.
Mulroy MF, Wills RP. Spinal anesthesia for outpatients: appropriate agents and techniques. J Clin Anesth 1995; 7: 622–7.
Pavlin DJ, Rapp SE, Polissar NL, Malgren JA, Koerschgen M, Meyes H Factors affecting discharge time in adult outpatients. Anesth Analg 1998; 87: 816–26.
Vaghadia H, McLeod DH, Mitchell GWE, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine- fantanyl spinal anesthesia for short duration outpatient laparoscopy. I A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg 1997; 84: 59–64.
Derville MT, Lang CE, Boogaerts JG. Time to discharge after general versus regional anaesthesia. Br J Anaesth 1997; 78(Suppl I): A3 (Abstract).
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 942–34.
Chung F. Are discharge criteria changing? J. Clin. Anesth 1993; 5 (Suppl 1): 64S-8S.
Bromage PR Epidural Analgesia. Philadelphia: W.B. Saunders Company, 1978: 144.
Dahl V, Gierløff C, Omland E, Raeder JC Spinal, epidural or propofol anaesthesia for out-patient knee arthroscopy? Acta Anaesthesiol Scand 1997; 41: 1341–5.
Halpern S, Preston R. Postdural puncture headache and spinal needle design. Anesthesiology 1994; 81: 1376–83.
Brown EM, Elman DS. Postoperative backache. Anesth Analg 1961; 40: 683–5.
Buettner J, Wresch K-P, Klose R. Postdural puncture headache: omparison of 25-gauge between Whitacre and Quincke needles. Reg Anesth 1993; 18: 166–9.
Bainton CR, Strichartz GR. Concentration dependence of lidocaine-induced irreversible conduction loss in frog nerve. Anesthesiology. 1994; 81: 657–67.
Hodgson PS, Neal JM, Pollock JE, Liu SS. The neurotoxicity of drugs gives intrathecally (spinal). Anesth Analg 1999; 88: 797–809.
Pollock JE, Liu SS, Neal JM, Stephenson CA Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology. 1999; 90: 445–50.
Freedman K, Li D-K, Drasner K, et al., and the Spinal Anesthesia Study Group. Transient neurologic symptoms after spinal anesthesia. An epidemiologic study of 1,863 patients. Anesthesiology 1998; 89: 633–41.
Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology 1996; 84: 1361–7.
Morisaki H, Masuda J, Kaneko S, Matsushima M, Takeda J. Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia. Anesth Analg 1998; 86: 1023–6.
Rowlingson JC To avoid “transient neurologic symptoms” — the search continues (Editorial). Reg Anesth Pain Med 2000; 25: 215–7.
Tessler MJ, Kardash K, Kleiman S, Rossignol M. A retrospective comparison of spinal and general anesthesia for vaginal hypterectomy: a time analysis. Anesth Analg 1995; 81: 694–6.
Dexter F, Tinker JH. Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology 1995; 82: 94–101.
Dexter F, Macario A, Manberg PJ, Lubarsky DA. Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg 1999; 88: 1053–63.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wong, J., Marshall, S., Chung, F. et al. Spainal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy. Can J Anesth 48, 369–374 (2001). https://doi.org/10.1007/BF03014965
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03014965