A comparison of selective spinal anesthesia with hyperbaric bupivacaine and general anesthesia with desflurane for outpatient knee arthroscopy

• Published in: Anesthesia and analgesia Vol. 99; no. 6; pp. 1668 - 1673
• Main Authors: KORHONEN, Anna-Maija, VALANNE, Jukka V, JOKELA, Ritva M, RAVASKA, Pirjo, KORTTILA, Kari T
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.12.2004
• Subjects: Adult; Ambulatory Surgical Procedures; Anesthesia; Anesthesia Recovery Period; Anesthesia, General - adverse effects; Anesthesia, Spinal - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - adverse effects; Anesthetics, Local - adverse effects; Arthroscopy; Biological and medical sciences; Bupivacaine - adverse effects; Female; Humans; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Knee - surgery; Male; Medical sciences; Middle Aged; Postoperative Care; Postoperative Nausea and Vomiting - epidemiology; Volatile compound; Knee; General anesthesia; Local anesthetic; Arthroscopy; Bupivacaine; General anesthetic; Desflurane; Carboxamide; Organic amide; Ambulatory; Anilide; Comparative study; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000139351.40608.05

In this randomized and controlled trial, 64 adult ambulatory knee arthroscopy patients received either selective spinal anesthesia (SSA) with 4 mg of hyperbaric bupivacaine or general anesthesia (GA) with desflurane. We conducted the study to determine whether SSA with small-dose bupivacaine provides equal fast-tracking possibilities, a shorter stay in the postanesthesia care unit, and earlier discharge home compared with GA with desflurane. Patients with a high risk for postoperative nausea and vomiting received prophylaxis in the GA group. No difference was seen in the fast-tracking possibilities or time in the postanesthesia care unit between the groups. Home readiness was achieved after 114 (31-174) and 129 (28-245) min (NS) in the SSA and GA groups, respectively. In the hospital, the pain scores were significantly (P < 0.001) lower in the SSA group compared with the GA group and the need for postoperative opioids was significantly (P = 0.008) larger after GA. The incidence of postoperative nausea and vomiting was 0% versus 19% in the SSA and GA groups (P = 0.024), respectively. We conclude that for outpatients undergoing knee arthroscopy, SSA with hyperbaric bupivacaine provides equal recovery times with less frequent side effects compared with GA with desflurane.