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AMBULATORY ANESTHESIA

A Comparison of Minidose Lidocaine-Fentanyl Spinal Anesthesia and Local Anesthesia/Propofol Infusion for Outpatient Knee Arthroscopy

Bruce Ben-David, MD^*, Patrick J. DeMeo, MD, Christen Lucyk, RN, ADN^*, and David Solosko, MD^*

Departments of *Anesthesiology and Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Bruce Ben-David, MD, Department of Anesthesia, Allegheny General Hospital, 320 East North Ave., Pittsburgh, PA 15212. Address e-mail to bbendavid{at}mindspring.com

Traditional methods of spinal anesthesia have proven problematic in the outpatient setting. Minidose lidocaine-fentanyl spinal anesthesia (SAB_MLF) may be the adaptation necessary to reestablish spinal anesthesia in this venue. One hundred patients scheduled for outpatient knee arthroscopy were randomized to receive either local anesthesia plus a titrated IV propofol infusion (LA/PI) or SAB_MLF using 20 mg lidocaine 0.5% + 20 µg fentanyl. Patients received midazolam 0.02–0.03 mg/kg IV and fentanyl 0.75–1.0 µg/kg IV upon arrival in the operating room before lumbar puncture or propofol infusion. The propofol infusion was begun at 50–75 µg · kg^-1 · min^-1 and titrated to maintain patient comfort. Boluses (200–400 µg/kg) were given as needed. Local anesthesia included 30 mL lidocaine 1% with epinephrine 1:200,000 intraarticularly plus 10 mL at the portal sites. Three patients (6%) in the LA/PI group versus none in the SAB_MLF group required general anesthesia. Airway support was required in 54% of the LA/PI patients and in none of the SAB_MLF patients. Total operating room time (43 vs 45 min), time to home readiness (43 vs 45 min), actual discharge times (73.5 min in both groups), and the incidence of discharge >90 min (22% vs 24%) were the same for both LA/PI and SAB_MLF groups. LA/PI and SAB_MLF groups differed in terms of postoperative pruritus (8% vs 68%), pain (44% vs 20%), nausea (8% vs 22%), and ability to void before discharge (56% vs 32%). One patient in each group had mild difficulty initiating voiding at home, but neither required medical attention. In both groups, 90% of patients were either "satisfied" or "very satisfied" with their anesthetic. The two techniques provided comparable patient satisfaction and efficiencies both intraoperatively and in postoperative recovery and discharge. The efficiencies of these techniques were not dependent on special provisions of the physical plant or the practice model.

IMPLICATIONS: Both local anesthesia supplemented by a titrated IV propofol infusion and minidose lidocaine-fentanyl spinal anesthesia for outpatient knee arthroscopy provide high patient satisfaction with equally rapid recovery and discharge.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999