Abstract ID: A23
Abstract Title: Local v Spinal Anesthesia for Knee Arthroscopy
Poster Type: Poster
ABSTRACT BODY
Introduction:
Fast tracking of patients postoperatively with early discharge has become a major concern in many institutions. This study compares spinal anesthesia (SA) to local anesthesia (LA) in terms of recovery from anesthesia, patient satisfaction, side effects, and associated costs.
Methods:
Thirty patients undergoing unilateral knee arthroscopy were prospectively randomized to one of two groups. Fourteen patients (SA group) received a spinal anesthetic with 3 ml of 1.5% mepivacaine (45 mg). Sixteen patients (LA group) received 30 ml of 2% lidocaine at the portal sites and 35 ml of 0.75% bupivacaine and 25 ml of 2% lidocaine intra-articularly. All patients received midazolam and/or propofol prior to the anesthetic at the discretion of the anesthesiologist. All patients were given oral analgesics as soon as could be tolerated prior to onset of pain.
An observer collected data on the day of surgery including any additional anesthetic requirements, intra-operative time, and length of stay. All patients were contacted by telephone on the first postoperative day. The incidence of back pain and headaches were determined as well as patient satisfaction score for the anesthetic experience.
Results:
There were no differences between the groups with respect to age, gender, height or weight (Table 1). The time required for administration of the anesthetic and duration of surgical procedure were also similar between the two groups (Table 2). The number of patients requiring additional sedation intra-op was higher in the LA group compared to the SA group (Table 2). The mean time spent in the PACU was significantly greater in the SA group compared with the LA group. Similarly, the PACU costs associated with group SA were significantly greater than those of group LA. There was no statistically significant difference in VAS score between the two groups in the recovery room. Spinal anesthesia was associated with back pain on the first post-operative day in 5 of 14 patients in the spinal group compared to none in the local group (p=0.004). There were no statistically significant differences between the two groups with respect to headache or overall patient satisfaction (Table 3).
Discussion:
While subjects receiving local anesthesia were more likely to require additional sedation intra-operatively compared to those who underwent spinal anesthesia, local anesthesia was associated with significantly faster discharge time from the PACU and consequently less PACU cost. After accounting for the increased cost associated with more propofol use, local anesthesia was on average, $200 less expensive than spinal anesthesia per case. Given that patients reported satisfaction with both types of anesthesia, local anesthesia appears to be a superior alternative to regional. The Healthcare Cost and Utilization Project estimates that over 37 million knee arthroscopies were performed in 2001. Hence these findings have important economic implications.
ATTACHED FILES
A23_Table1.doc
A23_Table2.doc
A23_Table3.doc
Reg Anesth Pain Med 2004; 29(2):A23