A prospective trial of local versus general anaesthesia for arthroscopic surgery of the knee.

We set out to determine if arthroscopic knee surgery was acceptable to patients and their surgeon when carried out using a local anaesthetic infiltration technique. Patients awaiting arthroscopy were randomly allocated to have either a local or a general anaesthetic. The same surgeon (NPT) carried out all the procedures. The demographic profile was similar in the two groups, as were the diagnosis and the surgical procedures. The only difference between the two groups was that those performed under local anaesthesia did not have a limb tourniquet inflated. The time spent in the theatre suite was similar in each group. This did not include the recovery time in the general anaesthetic group. The duration of the operation was longer in the local anaesthetic group (P = 0.05). A simple 0 to 10 scoring system indicated that patients preferred a local anaesthetic but the surgeon preferred to have the patient asleep (P > 0.05). Those having a local anaesthetic required less physiotherapy (P = 0.025) and more of them returned to work and sport earlier (P = 0.05). We attributed this to not having sustained pressure-induced tissue damage to the thigh muscle as they did not have a tourniquet inflated. We had a 4% failure rate in the local anaesthetic group. Arthroscopic surgery is already a well-established day case procedure and our findings have a financial implication (a saving of 25 pounds per case) as well as identifying a safer technique in the medically unfit. Unfortunately, this technique is not suitable for the investigation and treatment of all knee problems. There are certain constraints, viz the very anxious patient, acute problems, children, larger arthroscopic procedures and the inability to perform an examination under anaesthetic but, overall, it is a useful and effective way of performing a common surgical procedure.

RCT Entities:   Population Interventions Outcomes