LOCAL-ANESTHESIA IN OUTPATIENT KNEE ARTHROSCOPY - A COMPARISON OF EFFICACY AND COST

This study was performed to compare the efficacy, cost-effectiveness, and safety of general, regional, and local anesthesia when performing outpatient knee arthroscopy. The study consisted of two portions, A re trospective review of 256 outpatient knee arthroscopies was performed. The types of anesthesia used were general endotracheal, regional (epi dural or spinal), and local. Comparisons were made between operative p rocedure, anesthesia procedure time, need for supplemental anesthesia, recovery room time and cost, pharmaceutical cost, and complications. A prospective study consisted of 100 consecutive outpatient knee arthr oscopies performed using local anesthesia. Data identical to the retro spective portion were obtained. Visual analog scales were used in a pa tient questionnaire completed at the first postoperative visit to asse ss patient satisfaction with local anesthesia. The retrospective data showed similar demographics and operative procedures performed in the three study groups. The difference between operative time and total an esthetic time for the local group was 35 minutes less than for regiona l, and 23 minutes less than for the general group. These differences w ere statistically significant (P less than or equal to .05). Total pha rmaceutical cost was significantly less for the local group (P less th an or equal to .05). Recovery room cost for the local anesthesia group averaged $134 compared with $450 for regional and $527 for general. T his difference was significant (P less than or equal to .05). There we re 19 complications with general anesthesia, 16 with regional anesthes ia, and 2 with local. There were two regional and two local cases that needed subsequent general anesthesia. The prospective data showed nea rly identical time and cost data. The patient questionnaire showed nea rly universal acceptance and satisfaction with the use of local anesth esia. The use of local anesthesia for outpatient knee arthroscopy is s afe, effective, and well accepted. The use of local anesthesia was sho wn to save a minimum of $400 per case compared with the other anesthet ic methods studied.