Anesth Analg 2000;91:860-864
© 2000 International Anesthesia Research Society
AMBULATORY ANESTHESIA
A Comparison of Spinal, Epidural, and General Anesthesia for Outpatient Knee Arthroscopy
Michael F. Mulroy, MD,
Kathleen L. Larkin, MD,
Peter S. Hodgson, MD,
James D. Helman, MD,
Julia E. Pollock, MD, and
Spencer S. Liu, MD
Department of Anesthesiology, Virginia Mason Medical Center, Seattle Washington
Address correspondence and requests for reprints to Michael F. Mulroy, MD, Department of Anesthesiology, B2-AN, 1100 Ninth Ave., PO Box 900, Seattle, WA 98111. Address e-mail to anemfm{at}vmmc.org
We compared general, epidural, and spinal anesthesia for outpatient knee arthroscopy (excluding anterior cruciate ligament repairs). Forty-eight patients (ASA physical status IIII) were randomized to receive either propofol-nitrous oxide general anesthesia with a laryngeal mask airway with anesthetic depth titrated to a bispectral index level of 4060, 1520 mL of 3% 2-chloroprocaine epidural, or 75 mg of subarachnoid procaine with 20 µg fentanyl. All patients were premedicated with <0.035 mg/kg midazolam and <1 µg/kg fentanyl and received intraarticular bupivacaine and 1530 mg of IV ketorolac 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. Statistical analysis was performed with analysis of variance and 2. Postanesthesia care unit discharge times for the general and epidural groups were similar (general = 104 ± 31 min, epidural = 92 ± 18 min), whereas the spinal group had a longer recovery time (146 ± 52 min) (P = 0.0003). Patient satisfaction was equally good in all three groups (P = 0.34). Room turnover times did not differ among groups (P = 0.16). There were no anesthetic failures or serious adverse events in any group. Pruritus was more frequent in the spinal group (7 of 16 required treatment) than in the general or epidural groups (no pruritus) (P < 0.001). We conclude that epidural anesthesia with 2-chloroprocaine provides comparable recovery and discharge times to general anesthesia provided with propofol and nitrous oxide. Spinal anesthesia with procaine and fentanyl is an effective alternative and is associated with a longer discharge time and increased side effects.
Implications: For outpatient knee arthroscopy, anesthesia can be provided adequately with regional or general anesthesia. Epidural and general anesthesia provide equal recovery times and patient satisfaction, whereas spinal anesthesia may prolong recovery and have increased side effects. The choice of anesthesia may depend primarily on the patients interest in being alert or asleep during the procedure.
This article has been cited by other articles:

|
 |

|
 |
 
C. Gonano, U. Leitgeb, C. Sitzwohl, G. Ihra, C. Weinstabl, and S. C. Kettner
Spinal Versus General Anesthesia for Orthopedic Surgery: Anesthesia Drug and Supply Costs
Anesth. Analg.,
February 1, 2006;
102(2):
524 - 529.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. S. Liu, W. M. Strodtbeck, J. M. Richman, and C. L. Wu
A Comparison of Regional Versus General Anesthesia for Ambulatory Anesthesia: A Meta-Analysis of Randomized Controlled Trials
Anesth. Analg.,
December 1, 2005;
101(6):
1634 - 1642.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Flaishon, P. Ekstein, H. Matzkin, and A. A. Weinbroum
An Evaluation of General and Spinal Anesthesia Techniques for Prostate Brachytherapy in a Day Surgery Setting
Anesth. Analg.,
December 1, 2005;
101(6):
1656 - 1658.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Hadzic, P. E. Karaca, P. Hobeika, G. Unis, J. Dermksian, M. Yufa, R. Claudio, J. D. Vloka, A. C. Santos, and D. M. Thys
Peripheral Nerve Blocks Result in Superior Recovery Profile Compared with General Anesthesia in Outpatient Knee Arthroscopy
Anesth. Analg.,
April 1, 2005;
100(4):
976 - 981.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Schuster, A. Gottschalk, J. Berger, and T. Standl
A Retrospective Comparison of Costs for Regional and General Anesthesia Techniques
Anesth. Analg.,
March 1, 2005;
100(3):
786 - 794.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. R. Yoos and D. J. Kopacz
Spinal 2-Chloroprocaine: A Comparison with Small-Dose Bupivacaine in Volunteers
Anesth. Analg.,
February 1, 2005;
100(2):
566 - 572.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. F. Gonter and D. J. Kopacz
Spinal 2-Chloroprocaine: A Comparison with Procaine in Volunteers
Anesth. Analg.,
February 1, 2005;
100(2):
573 - 579.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A.-M. Korhonen, J. V. Valanne, R. M. Jokela, P. Ravaska, and K. T. Korttila
A Comparison of Selective Spinal Anesthesia with Hyperbaric Bupivacaine and General Anesthesia with Desflurane for Outpatient Knee Arthroscopy
Anesth. Analg.,
December 1, 2004;
99(6):
1668 - 1673.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. J. Jankowski, J. R. Hebl, M. J. Stuart, M. G. Rock, M. W. Pagnano, C. M. Beighley, D. R. Schroeder, and T. T. Horlocker
A Comparison of Psoas Compartment Block and Spinal and General Anesthesia for Outpatient Knee Arthroscopy
Anesth. Analg.,
October 1, 2003;
97(4):
1003 - 1009.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. E. Pollock, M. F. Mulroy, E. Bent, and N. L. Polissar
A Comparison of Two Regional Anesthetic Techniques for Outpatient Knee Arthroscopy
Anesth. Analg.,
August 1, 2003;
97(2):
397 - 401.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. H. Lennox, C. Chilvers, and H. Vaghadia
Selective Spinal Anesthesia Versus Desflurane Anesthesia in Short Duration Outpatient Gynecological Laparoscopy: A Pharmacoeconomic Comparison
Anesth. Analg.,
March 1, 2002;
94(3):
565 - 568.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. H. Lennox, H. Vaghadia, C. Henderson, L. Martin, and G. W. E. Mitchell
Small-Dose Selective Spinal Anesthesia for Short-Duration Outpatient Laparoscopy: Recovery Characteristics Compared with Desflurane Anesthesia
Anesth. Analg.,
February 1, 2002;
94(2):
346 - 350.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. V. Valanne, A.-M. Korhonen, R. M. Jokela, P. Ravaska, and K. K. Korttila
Selective Spinal Anesthesia: A Comparison of Hyperbaric Bupivacaine 4 mg Versus 6 mg for Outpatient Knee Arthroscopy
Anesth. Analg.,
December 1, 2001;
93(6):
1377 - 9.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. S. Aye, K. Drasner, R. Morell, J. Prielipp, T. R. Hill, N. Swissman, T. A. Mayer, R. J. Cates, S. Jackson, J. Daley, et al.
A Patient Dissatisfied With Her Care
JAMA,
September 19, 2001;
286(11):
1311 - 1315.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. Ben-David, P. J. DeMeo, C. Lucyk, and D. Solosko
A Comparison of Minidose Lidocaine-Fentanyl Spinal Anesthesia and Local Anesthesia/Propofol Infusion for Outpatient Knee Arthroscopy
Anesth. Analg.,
August 1, 2001;
93(2):
319 - 325.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. S. Reuben and M. F. Mulroy
Ambulatory Anesthesia for Knee Arthroscopy
Anesth. Analg.,
February 1, 2001;
92(2):
556 - 556.
[Full Text]
[PDF]
|
 |
|
|