A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy

We compared general, epidural, and spinal anesthesia for outpatient knee ar throscopy (excluding anterior cruciate ligament repairs). Forty-eight patie nts (PISA physical status I-III) were randomized to receive either propofol -nitrous oxide general anesthesia with a laryngeal mask airway with anesthe tic depth titrated to a bispectral index level of 40-60, 15-20 mL of 3% 2-c hloroprocaine epidural, or 75 mg of subarachnoid procaine with 20 mu g fent anyl. All patients were premedicated with <0.035 mg/kg midazolam and <1 mu g/kg fentanyl and received intraarticular bupivacaine and 15-30 mg of IV ke torolac during the procedure. Recovery times, operating room turnover times , and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction. S tatistical analysis was performed with analysis of variance and chi(2). Pos tanesthesia care unit discharge times for the general and epidural groups w ere similar (general = 104 +/- 31 min, epidural = 92 +/- 18 min), whereas t he spinal group had a longer recovery time (146 +/- 52 min) (P = 0.0003). P atient satisfaction was equally good in all three groups (P = 0.34). Room t urnover times did not differ among groups (P = 0.16). There were no anesthe tic failures or serious adverse events in any group. Pruritus was more freq uent in the spinal group (7 of 16 required treatment) than in the general o r epidural groups (no pruritus) (P < 0.001). We conclude that epidural anes thesia with 2-chloroprocaine provides comparable recovery and discharge tim es to general anesthesia provided with propofol and nitrous oxide. Spinal a nesthesia with procaine and fentanyl is an effective alternative and is ass ociated with a longer discharge time and increased side effects.