COST-EFFECTIVENESS OF INHALATIONAL, BALANCED AND TOTAL INTRAVENOUS ANESTHESIA FOR AMBULATORY KNEE SURGERY

Purpose: A randomized, blinded clinical trial was undertaken to compar e recovery characteristics and cost-benefits associated with three gen eral anaesthetic techniques for arthroscopic knee surgery in an ambula tory care setting. Methods: Ninety three, ASA Physical Status I-II pat ients were randomly allocated to receive one of three types of general anaesthesia: isoflurane/fentanyl/N2O (Group INH); alfentanil/N2O (Gro up BAL); or propofol/alfentanil/O-2 (Group TIVA). Postoperative recove ry profiles were evaluated at 30, 60, 90 and 120 min after emergence f rom anaesthesia, and direct and indirect costs of each anaesthetic wer e compared. Results: The most rapid emergence was observed in Group BA L (2.2 +/- 1.5 min, P < 0.0001 compared with groups INH and TIVA), alt hough the incidence of post-operative nausea and vomiting was also hig hest in this group (P = 0.02 compared with groups INH and TIVA). Howev er, overall patient satisfaction, and mean times to discharge from the Post Anaesthesia Recovery Unit and hospital, were rapid and similar i n all three groups. During anaesthesia which lasted 40-45 min, nearly a four-fold difference was observed in the direct costs of anaesthetic drugs: $16.4 +/- 4.4 (Group INH), $45.3 +/- 11.4 (Group BAL) and $63. 4 +/- 17.9 (Group TIVA, P < 0.001 between groups); while indirect cost s were similar. Conclusions: For arthroscopic knee surgery, INH anaest hesia with isoflurane/fentanyl/N2O is associated with similar hospital discharge times, and comparable levels of patient satisfaction as eit her BAL or TIVA. While indirect costs were similar, lower direct costs suggest that there may be a pharmacoeconomic benefit associated with the use of a ''standard'' isoflurane/fentanyl/N2O anaesthetic in certa in day care surgery procedures.