Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study.

BACKGROUND: Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. TYPE OF STUDY: Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. METHODS: The intra-operative requirement of sevoflurane was studied in forty-four ASA 1-2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40-50 during surgery. RESULTS: All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2) and 0.91 (SD 0.2) for the pre and post-operative administered group of patients respectively (p < 0.0001). No other intra-operative differences could be noted. Emergence and recovery was rapid and no difference was noticed in time to discharge-eligible mean 52 minutes in both groups studied. In all 6 patients, 5 in the group receiving etoricoxib post-operatively, after surgery, and one in the pre-operative group required rescue analgesia before discharge from hospital. No difference was seen in pain or need for rescue analgesia, nausea or patients satisfaction during the first 24 postoperative hours. CONCLUSION: Coxib premedication before elective day surgery has an anaesthetic sparing potential.

Pain after elective arthroscopy of the knee: a prospective, randomised, study comparing conventional NSAID to coxib.

Although outpatient knee arthroscopy is probably by far the most frequently performed orthopaedic procedure, there are limited guidelines or consensus concerning the peroral postoperative pain management. A diversity of analgesics both in potency and action is prescribed. The purpose of the present investigation was to grade the pain and need for rescue medication during the first 4 days after the knee arthroscopy, comparing a conventional nonsteroidal anti-inflammatory drug (NSAID) with a selective cox-II-inhibitor (coxib) as postoperative pain medication. One hundred and twenty-two patients scheduled for primary elective knee arthroscopy in general anaesthesia were randomised to either a NSAID (lornoxicam) or a selective cox-II-inhibitor (rofecoxib) postoperatively. Pain ratings and the need for rescue medication were followed for four consecutive days. Side effects were also registered. The need for rescue analgesics was highest the evening after surgery, when 42% of patients required one, or more, oral additional analgesics. The use of rescue medication decreased with time and 30, 25, 16 and 11% of the patients required additional analgesics for day 1 to 4, respectively, still 50% of all patients required at some point one or more rescue analgesics. Overall pain ratings were low, and showed similar pattern with evening and day, 50% of all patients required at some point one or more rescue analgesics. We found, however, no differences in pain ratings, or need for rescue analgesics between the two groups, conventional NSAID and coxib as well as no difference in side-effect profile. In conclusion, patients do require proper pain management also after minor outpatient surgical procedures such as knee arthroscopy. The traditional NSAIDs seem to be the first choice for analgesic and anti-inflammatory effects, when needed after elective arthroscopy of the knee.

The postoperative analgesic effects of intra-articular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study.

PURPOSE: Pain and emesis are the two major complaints after day surgery. Local anesthesia has become an important part of optimizing perioperative pain treatment. The aim of the present study was to study two different concentrations of levobupivacaine's effect on postoperative pain following elective arthroscopy of the knee with lidocaine 10 mg/ml with adrenaline as active control. TYPE OF STUDY: Prospective, randomized double-blind study with lidocaine as active control but without placebo. METHODS: One hundred and twenty patients were studied comparing levobupivacaine 2.5 mg/ml, levobupivacaine 5 mg/ml, and lidocaine 10 mg/ml with adrenaline given intra-articularly at the end of day-case operative elective arthroscopy of the knee done in light general anesthesia. Primary study endpoint was the need for any analgesics during the first 24 postoperative hours. RESULTS: Levobupivacaine 5 mg/ml was associated with a reduced need for any analgesia during the entire 24-h study period (p = 0.013) as compared to both 2.5 mg/ml levobupivacaine and lidocaine with adrenaline. Levobupivacine 2.5 mg/ml was inferior to lidocaine with regard to pain relief with an increase in need for oral analgesia already during stay in the recovery unit (p < 0.001). CONCLUSIONS: Levobupivacaine 5 mg/ml was found to be an effective local anesthetic in day-case operative arthroscopy of the knee providing superior postoperative analgesia as compared to lidocaine with adrenaline or a lower concentration of levobupivacaine. LEVEL OF EVIDENCE: Level I: Prospective, randomized double-blind study without placebo.

Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost.

To evaluate the cost and time effectiveness for different anesthesia methods when performing knee arthroscopy, this study compared three different anesthesia methods. Four hundred healthy patients scheduled for knee arthroscopy were randomized to either local anesthesia (LA) (n=200), spinal anesthesia (SA) (n=100) or general anesthesia (GA) (n=100). The LA arthroscopies were performed in a facility set up in our outpatient department without anesthesia service. The SA and GA arthroscopies were performed in our central operating department with full anesthesia service. Comparisons were made between total hospital stay, anesthesia time, surgery time, recovery time, pharmaceutical and total cost. The total hospital time was 130.4 min (SD 35.14, range 63-383) in the LA group compared to 280.4 min (SD 79.29, range 155-589) in the GA group (p<0.001). The total hospital time in the GA group was also shorter than that of 350.3 min (SD 65.37, range 198-502) in the SA group (p<0.001). The time from start of anesthesia to start of surgery was significantly longer in the LA group, 39.2 min (SD 13.13, range 17-87), compared to 20.1 min (SD 4.93, range 11-35) in the SA group and to 17.6 min (SD 4.64, range 9-44) in the GA group. There were no differences in the surgery time for the three groups. The use of LA was shown to save SEK 1011 (Swedish Crowns) per patient compared to SA and GA.

Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up.

Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.