Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

Eur J Anaesthesiol. 2018 Oct;35(10):774-781. doi: 10.1097/EJA.0000000000000794.

Abstract

Background: Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication.

Objective: The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs.

Design: A randomised controlled single-centre trial.

Setting: University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015.

Patients: A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion.

Interventions: Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up.

Main outomes: Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs.

Results: Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096).

Conclusion: Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general.

Trial registration: German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / methods*
  • Anesthesia, Intravenous
  • Anesthetics, Local / administration & dosage*
  • Arthroscopy / adverse effects
  • Arthroscopy / methods*
  • Drug Compounding
  • Female
  • Follow-Up Studies
  • Humans
  • Infusions, Intravenous
  • Infusions, Spinal / methods*
  • Knee / pathology
  • Knee / surgery*
  • Male
  • Middle Aged
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / etiology
  • Patient Satisfaction
  • Procaine / administration & dosage
  • Procaine / analogs & derivatives*

Substances

  • Anesthetics, Local
  • Procaine
  • chloroprocaine