2015 ISAKOS Biennial Congress ePoster #1110
Results of Use of Local Anaesthesia With Intra-Venous Sedation in Non-Reconstructive Knee Arthroscopy in 351 Consecutive Procedures, With Focus on Effectiveness, Need for Patient Selection and Level of Sedation
Arno Smit, MD, FRCSC, White Rock, BC CANADA
White Rock Orthopaedic Surgery Centre, White Rock, British Columbia, CANADA
FDA Status Cleared
Summary: Local anesthesia with intra-venous sedation was found efficacious in performing 351 consecutive non-reconstructive knee arthroscopy procedures, without the need for patient selection or excessive sedation.
Local anaesthesia with intra-venous sedation for knee arthroscopy remains relatively infrequently used, despite having been established as safe and effective. Concerns regarding the need for patient selection, excessive sedation and lack of consistency have limited its use. This study reports a single surgeon experience with 351 consecutive non-reconstructive unilateral knee arthroscopies, performed over a five-year period (2008-2013).
Prospectively collected data regarding 351 consecutive unilateral non-reconstructive knee arthroscopy procedures performed in a single non-hospital surgical facility were reviewed. All surgery was initiated with intravenous sedation at the discretion of the anaesthesiologist. The knee was then prepared for surgery by the surgeon through infiltration of the subcutaneous tissues and intra-articular injection using a local anaesthetic mixture (bupivacaine 2 mg/ml, ketorolac 0.3 mg/ml, epinephrine 1:200.000 in normal saline). A minimum of 10 minutes was observed from administration of local anaesthetic to surgery. Level of intra-operative sedation was determined by the anaesthesiologist. Upon procedure completion, standard nursing protocol, based on Aldrete scores, was used in the post-anaesthesia care unit(PACU). At discharge, a quality improvement/patient satisfaction questionnaire was provided, with the request to return this to the facility within two weeks. Patient demographics were established. The following outcomes are reported: 1/completion of surgical goals. 2/utilization data of operating room and PACU. 3/medication utilization in operating room. 4/PACU pain scores. 5/PACU sedation scores. 6/PACU discharge scores. 7/ questionnaire-derived patient satisfaction scores.
Patient demographics. Gender: male 183(52%), female 168(48%). Age(years): average(±standard deviation(SD)) 55(±15), range 13-86, median 56). Weight(kg): average(±SD) 83.4(±16.6), range 45-133, median 82. Body mass index(‘BMI’, kg/m²): average(±SD) 27.6(±4.2), range 18.3-39.8, median 27.2. ASA classification: ASA-1 57.8%, ASA-2 40.5%, ASA-3 1.7%.
1/Completion of surgical goals was achieved in all cases. No procedures were aborted. No conversion to general anaesthesia was required. No tourniquet use was necessary.
2/Duration of surgery(minutes): average(±SD) 17(±8), range 5-93, median 16.
PACU utilization(minutes): average(±SD) 48(±13), range 17-116, median 45.
Facility time from entrance into operating room to discharge(minutes): average(±SD) 99(±19), range 66-255, median 97
3/Operating room medication:
Bupivacaine(mg/kg, used in all cases): average(±SD) 2.18(±28), range 0.82-2.92, median 2.12.
Fentanyl(mcg, 350/351 cases): average(±SD) 70.5(±24.8), range 25-150, median 50. Midazolam(mg, 336/351cases): average(±SD) 2.2(±0.85), range 1-6, median 2. Propofol(mg, 285/351 cases): average(±SD) 143(±104), range 20-600, median 120.
4/PACU pain scores (visual analogue scale(VAS):0-10, ‘0’ no pain, ‘10’ most severe pain). Score 0/10: 303 patients(86%), 1-2/10: 38 patients(11%), 3-4/10: 7 patients(2%), 5-6/10: 0 patients(0%), 7-8/10: 1 patient(0.3%), 9-10/10: 0 patients(0%).
5/ PACU sedation scores. A/Upon PACU admission. Fully-awake: 238 patients(68%). Rousable-by-voice: 98 patients(27%). Non-responsive: 16 patients(5%). B/Twenty minutes after PACU admission. Fully-awake: 345 patients(98%), Rousable-by-voice: 7 patients(2%). Non-responsive: 0 patients(0%). C/At discharge. Fully-awake: 351 patients(100%).
6/ Discharge Aldrete scores.10/10: 343 patients(97%), 9/10: 8 patients(3%).
7/ Questionnaires returned: 117(30%). Overall satisfaction (VAS 0-10): 78% ‘very satisfied’(9-10/10), 20% ‘quite satisfied’(7-8/10), 2% ‘merely satisfied’(5-6/10).
Local anaesthesia with intra-venous sedation allows expedient and predictable non-reconstructive knee arthroscopy in a non-hospital facility setting, without the need for case selection or excessive sedation. Surgical goals can reliably be met. Patient satisfaction has been confirmed.