Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia

Local anesthesia (LA) for outpatient knee arthroscopy is not a standard pro cedure at most hospitals. To evaluate the LA technique for knee arthroscopy on medically healthy patients, this study compared 3 anesthesia techniques . Four hundred patients were randomized to either local (n = 200), general (n = 100), or spinal (n = 100) anesthesia. Evaluated outcomes included the patient's subjective view of the procedure, and nausea and pain at rest and during active movement. All variables were recorded perioperatively and po stoperatively. In addition, the performing surgeon's opinion of the degree of patient pain and the technical difficulty of the procedure were noted. T hree hundred forty-two patients completed the study. In the group receiving local anesthesia (n = 180) the median visual analog scale pain score durin g surgery was 6 mm (mean, 17.5; SD, 23.2; range, 0 to 100 mm). Twenty-one L A patients would have preferred another form of anesthesia. In 29 patients, LA was not considered as the optimal anesthesia by the performing surgeon. Eight LA patients agreed with the surgeon that the anesthesia method used was not optimal, of these patients, 5 had synovitis (3%). In 5% of the LA p atients there were technical problems. Thus, this study shows that elective knee arthroscopy can be performed under local anesthesia in 92% of the pat ients from a technical point of view. Excluding patients who do not choose local anesthesia and those who have hypertrophic synovitis preoperatively, knee arthroscopies can be performed as safely and effectively under local a nesthesia as under any other form of anesthesia. For most patients, local a nesthesia can be recommended as the standard procedure for outpatient knee arthroscopy.