ARTHROSCOPY UNDER LOCAL ANAESTHESIA
ABSTRACTS:
Between February 1997 and December 1997- 52 arthroscopies of the knee was performed using local anaesthetic technique. Arthroscopy was performed as an outpatient procedure using the standard antero-lateral approach. This technique provided satisfactory operating condition and satisfactory patient acceptability.
PATIENTS AND METHODS:
52 consecutive patients were called upon to operation theatre as outpatients after being thoroughly examined and properly investigated. Each patient was treated as follows: - In the operation theatre, an intravenous canula was inserted and 10 ml. Diazepam was given. The Surgeon with an indelible pen marked the desired entry portals on the skin. Each desired portal was infiltrated widely using 10 ml. Of 0.5 % Lignocaine hydrochloride with 1 in 200, 000 adrenaline from skin to synovium after preparation with Betadine solution. Then 50 ml. Of Lignocaine with adrenaline were injected in to the joint. The knee was extended and flexed for several times and about 15minutes allowed for the anaethesia to take effect. The patient was observed and pulses blood pressure monitored. Then the Arthroscopy was carried out using the normal technique, but without tourniquet.
All the patients were sent home after 3 hours. Again all were seem in OPD after 10 days when stitches were removed and they were asked if they would have the same anaethesia should they need another Arthroscopy.
Table 1 Showing Diagnosis in 52 Patients:
|
Loose Body |
2 |
|
Medial meniscus lesion |
10 |
|
Anterior cruciate ligament rupture |
7 |
|
Osteoarthritis |
20 |
|
Chondromalacia patellae |
8 |
|
Tubercular Knee |
4 |
|
Diffuse synovitis |
1 |
|
Total |
52 |
Table Showing Operative procedure performed:
|
Loose Body removal |
2 |
|
Synovial Biopsy |
4 |
|
Lavage |
13 |
|
Partial Meniscectomy |
4 |
|
Total |
23 |
RESULTS:
OPERATIVE CONDITIONS;
A satisfactory view was obtained in all cases. Only in 5 patients at first the view was obscured by blood but cleared in flushing with saline without loss of anaethesia. Pre- operative examination of the knee for locking and laxity of the cruciate ligament was possible but not for the collateral ligaments.
The duration of anaesthesia was quite sufficient in all cases and the operating time ranging from 10 to 45 minutes.
PATIENT ACCEPTAILITY:
In all of the patients anaesthesia was satisfactory except in two who required general anaesthesia. Of the remaining 50 patients, 48 would have been happy to have the same anaethesia for an Arthroscopy in near future.
SAFITY:
Neither there was any post- operative infection, nor were any adverse respiratory, cardiovascular or toxic side effects seen.
DISCUSSION:
Arthroscopy o the knee is being carried out in our hospital since last 5 years. Initially Arthroscopy was being carried out under general aneasthesia or spinal anaesthesia. Because of very limited operating time and of limited beds both of these anaethestic techniques proved unsuitable for day patients. We always had to keep the patients under observation atleast for few hours. So, gradually we developed the technique of Arthroscopy under local anaesthesia and the technique proved to be simple and safe for day case- diagnostic and for few operating procedures. It is suitable for patients who might be considered unfit for general anaesthesia and as no tourniquet is used muscle tone is maintained, immediate post- operative mobilization is possible. A rapid turn over of the patient can be achieved and in our study all the patients had left hospital after 3 hours. Few contra-indications include a patient having hypertension, a nervous patient, and a patient with an injured knee.
CONCLUSION:
It is concluded that intra-aricular injection of Lignocaine with adrenaline is safe, simple, effective and well tolerated method of anaesthesia for Arthroscopy of the knee.
Siddhartha Apollo Hospital
Kamaladi- Putalisadak
Kathmandu, Nepal.
Tel: +977-1-426959/61
Fax: 977-1-426963