Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medical Statistics, University Medical Centre Mannheim, Ruprecht-Karls-University Heidelberg, Heinrich-Lanz-Zentrum, 68135, Mannheim, Germany.
Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):3032-3040. doi: 10.1007/s00167-018-5327-2. Epub 2018 Dec 14.
Knee arthroscopies are regularly carried out in an outpatient setting. The purpose of this retrospective analysis was to investigate the impact of different local anaesthetics for spinal anaesthesia on operating room efficiency (perioperative process times) and postoperative recovery. This study aims to determine the optimal LA for SPA in patients undergoing knee arthroscopy at a day-surgery centre.
Anaesthesia records of all patients undergoing knee arthroscopy under spinal anaesthesia from 2010 until 2017 were analysed. Patients were categorised as having received spinal anaesthesia with prilocaine, mepivacaine or chloroprocaine.
Three-hundred and nine patients were included. Postoperative recovery was significantly faster for chloroprocaine 1% compared with both other local anaesthetics regarding all stages of recovery until discharge. Perioperative processes and surgery time were significantly shorter when chloroprocaine was used. Early postoperative pain occurred more frequently and earlier after spinal anaesthesia with chloroprocaine. Nevertheless, pain intensity did not differ between groups.
Spinal anaesthesia provides reliable blocks for outpatient knee arthroscopy. Considerations on the choice of local anaesthetic for spinal anaesthesia must include not only the recovery profile, but also the impact on operating room efficiency. Due to a superior recovery profile, low incidences of adverse side effects and raised operating room efficiency, chloroprocaine is the recommendable local anaesthetic for spinal anaesthesia in patients undergoing knee arthroscopy in an ambulatory setting. Since the frequency of SPA in patients undergoing outpatient knee arthroscopy is rising yearly, the results of this study are of high clinical relevance. The use of chloroprocaine leads to improved recovery, optimized perioperative processes and consecutively to a raised OR efficiency.
III.
膝关节镜检查通常在门诊环境下进行。本回顾性分析的目的是研究不同局部麻醉药用于椎管内麻醉对手术室效率（围手术期时间）和术后恢复的影响。本研究旨在确定日间手术中心行膝关节镜检查患者行椎管内麻醉时的最佳局部麻醉药。
分析了 2010 年至 2017 年间所有接受椎管内麻醉下膝关节镜检查的患者的麻醉记录。将患者分为接受普鲁卡因、甲哌卡因或氯普鲁卡因椎管内麻醉的患者。
共纳入 309 例患者。与其他两种局部麻醉药相比，氯普鲁卡因 1%在所有恢复阶段直至出院时的术后恢复均明显更快。使用氯普鲁卡因时，围手术期过程和手术时间明显更短。氯普鲁卡因椎管内麻醉后早期发生的术后疼痛更频繁且更早。然而，各组之间的疼痛强度没有差异。
椎管内麻醉可为门诊膝关节镜检查提供可靠的阻滞。在选择椎管内麻醉的局部麻醉药时，不仅要考虑恢复情况，还要考虑对手术室效率的影响。由于氯普鲁卡因具有更好的恢复情况、较低的不良反应发生率和更高的手术室效率，因此对于在日间手术环境下行膝关节镜检查的患者，氯普鲁卡因是椎管内麻醉的推荐局部麻醉药。由于每年接受门诊膝关节镜检查的 SPA 患者数量不断增加，因此本研究结果具有重要的临床意义。使用氯普鲁卡因可改善恢复情况、优化围手术期过程，并提高手术室效率。
III 级。
