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Effects of different anaesthetic techniques on postoperative pain following arthroscopic knee surgery

Gürkhan, Y.; Kiliçkan, L.; Müezzinoğlu, S.; Canatay, H.; Toker, K.

European Journal of Anaesthesiology: 2000 - Volume 17 - Issue - p 11
European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000

Kocaeli University School of Medicine, Kocaeli, Turkey

Abstract A-35

Background and goal of study: Arthroscopic knee surgery is commonly performed as an outpatient procedure and providing adequate postoperative analgesia is important. Different anaesthetic techniques can be performed for arthroscopic knee surgery [1]. the purpose of this study was to compare the effects of general and spinal anaesthesia and three-in-one block on postoperative analgesia.

Material and methods: After obtaining institutional approval and patient consent 42 ASA I-II patients were assigned to three groups in a random manner.

In group I, general anaesthesia was induced with propofol 2.5 mg kg−1 IV and laryngeal mask was inserted. Anaesthesia was maintained with 66% N2O in O2 and sevoflurane. Narcotics were avoided during anaesthesia. In group II, spinal anaesthesia was performed in the lateral decubitus position and patients received 2 ml of 0.5% hyperbaric bupivacaine via 25-gauge Quincke needle at the L3-L4 or L4-L5 level. In group III, using a nerve stimulator three-in-one block was performed 30 minutes before the surgery and 30 ml mixture of lidocaine 2% and bupivacaine 0.5% was administered using the inguinal paravascular technique. Lateral femoral cutaneous nerve was also blocked using a 10 ml mixture of lidocaine 1% and bupivacaine 0.25%.

In the recovery room postoperative analgesia was provided with fentanyl (25 μg) bolus doses. Acetaminophen, 500 mg tablet PO, was given for the subsequent pain relief. Pain was assessed with a 10 cm VAS, performed before the surgery and at 1, 2, 3, 6, 12 and 24 hours after surgery. Kruskal Wallis test was used for statistical analysis.

Results and discussion: Demographic data, type and duration of surgery performed were similar in all three groups. Two patients in the three-in-one block group needed general anaesthesia to complete the operation and were excluded from the study.

VAS scores were significantly higher in group I at the postoperative 1st, 2nd, 3rd, 6th, 12th and 24th hours than group III (P<0.001). VAS scores were significantly higher in group I at the postoperative 1st and 2nd hours than group II (P<0.001). VAS scores were significantly higher in group II at the postoperative 2nd, 3rd., 6th, 12th and 24th hours than group III (P<0.001). In the postoperative period only patients in group I required fentanyl treatment (P<0.001). Acetaminophen consumption was significantly lower in group III than groups I and II (P<0.001).

Conclusion: Three-in-one block technique is more effective in pain control than general and spinal anaesthesia for arthroscopic knee surgery.

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1 Allen JG, Denny NM, Oakman N. Reg Anesth 1998; 23: 142-146.

Section Description

The abstracts published in this supplement have been typeset from camera-ready copies prepared by the authors. Every effort has been made to reproduce faithfully the abstracts as submitted. However, no responsibility is assumed by the organisers for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of methods, products, instructions or ideas contained in the material herein. Because of the rapid advances in medical sciences, we recommend that independent verification of diagnoses and drug doses should be made.

Ambulatory anaesthesia

© 2000 European Society of Anaesthesiology