European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
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 . 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.
1 Allen JG, Denny NM, Oakman N. Reg Anesth
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