Monzó E, Manzanos A, Cruz A, Ruiz-Uchupi P, Mansilla T
Mutua Patronal de Accidentes de Trabajo La Fraternidad, Madrid.
Rev Esp Anestesiol Reanim. 1992 Sep-Oct;39(5):312-5.
We performed local anesthesia of the knee for arthroscopic surgery in 1,000 patients who were diagnosed of meniscopathy, chondropathy, or block of the knee. We established two anesthetic times. The first consisted of an intraarticular administration of 40 ml of a mixture containing bupivacaine 0.5%, lidocaine 0.5% or prilocaine 1%, and adrenaline 1:200,000. The second was extraarticular and consisted of a local infiltration at the sites of entrance of the arthroscope or instrumental material with lidocaine 0.5% or prilocaine 1%, with adrenaline 1:100,000. We kept a latency period of 10 to 15 min, time required for setting up the arthroscopic procedure. Ischemia was systematically avoided. With this technique the following surgical treatments were performed: meniscectomy, curettage of articular cartilage, synovectomy, plica sections, and extraction of free bodies. Tolerance to surgery was excellent in 32.3% cases, good in 46.5%, regular in 16%, and bad in 5.2%. In no cases more complex anesthetic techniques were undertaken. We conclude that the anesthetic technique used in this study is appropriate for arthroscopic surgery of the knee and allows to perform ambulatory surgery. The procedure is not useful in cases of ligament reconstruction, regional infection, and rupture of the articular capsula. Although the anesthetic technique is easy some factors should be considered before indication of the procedure such as a careful selection of the patient, skillfulness of the surgeon in performing the arthroscopy, and the accuracy of the preoperative diagnosis.
我们对1000例被诊断为半月板病变、软骨病或膝关节阻滞的患者进行了膝关节局部麻醉以实施关节镜手术。我们设定了两种麻醉时间。第一种是关节腔内注射40毫升含有0.5%布比卡因、0.5%利多卡因或1%丙胺卡因以及1:200,000肾上腺素的混合液。第二种是关节外麻醉，即在关节镜或手术器械进入部位用0.5%利多卡因或1%丙胺卡因进行局部浸润，并加入1:100,000肾上腺素。我们保持10至15分钟的潜伏期，这是设置关节镜手术所需的时间。系统性地避免了局部缺血。采用这种技术进行了以下手术治疗：半月板切除术、关节软骨刮除术、滑膜切除术、皱襞切除术和游离体摘除术。32.3%的病例对手术耐受性极佳，46.5%良好，16%一般，5.2%较差。没有采用更复杂的麻醉技术。我们得出结论，本研究中使用的麻醉技术适用于膝关节镜手术，并允许进行门诊手术。该方法在韧带重建、局部感染和关节囊破裂的情况下无效。尽管麻醉技术简单，但在确定手术指征之前应考虑一些因素，如仔细选择患者、外科医生进行关节镜检查的熟练程度以及术前诊断的准确性。
