Can ultrasound-guided nerve block be a useful method of anesthesia for arthroscopic knee surgery?

ABSTRACT

PURPOSE: This study was performed to compare general anesthesia, spinal anesthesia, and ultrasound (US)-guided nerve block for knee arthroscopic surgery. Also, whether US-guided nerve block is a useful method of anesthesia for arthroscopic knee surgery was investigated. METHODS: In this prospective, randomized study, 400 patients who underwent knee arthroscopy surgery between February 2011 and September 2012 were allocated to one of three groups spinal anesthesia (n = 100), general anesthesia (n = 100), or US-guided nerve block (n = 200). All patients completed a questionnaire with three questions 6 months after surgery. For the nerve block group, the procedure duration, interval between the procedure and onset of the anesthetic effect, the point of loss of the anesthetic effect, intraoperative, postoperative visual analog scale (VAS) pain score, and discomfort during surgery were assessed. RESULTS: There was no patient in which the anesthetic was changed to another method during the operation. VAS pain score of postoperative 1 h was significantly different between the nerve block (1.4 ± 1.7), spinal anesthesia (1.5 ± 1.1), and general anesthesia groups (6.2 ± 5.1) (P < 0.05). In addition, VAS pain scores at postoperative 6 and 12 h were significantly different among the regional nerve block group (2.2 ± 1.5 and 3.0 ± 1.8, respectively), spinal anesthesia group (5.2 ± 3.2 and 5.1 ± 4.0, respectively), and general anesthesia group (5.2 ± 3.9 and 5.4 ± 4.5, respectively). One hundred and ninety regional nerve block (95 %), 68 spinal anesthesia (68 %), and 75 general anesthesia patients (75 %) reported that they would prefer the same type of anesthesia if they were to undergo knee surgery again; these differences were significant (P < 0.05). There were no long-term complications, such as neurological deficits or infection, after the procedure in all patients. CONCLUSION: Arthroscopic knee surgery, such as meniscal repair or meniscectomy, synovectomy, debridement, and other procedures, was performed safely and effectively under US-guided nerve block. These results indicated that US-guided nerve block for arthroscopic knee surgery is a highly satisfactory and safe procedure without complications and is available for use by any orthopedist. LEVEL OF EVIDENCE Prospective case series, Level IV.