Randomized comparison of remifentanil-propofol with a sciatic-femoral nerve block for out-patient knee arthroscopy
Casati, A.; Cappelleri, G.; Berti, M.; Fanelli, G.; Di Benedetto, P.; Torri, G.
European Journal of Anaesthesiology 19(2): 109-114
2002
ISSN/ISBN: 0265-0215 PMID: 11999592 Document Number: 542868
Background and objective: To evaluate preparation and discharge times as well as the anaesthesia-related costs of out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block, or a propofol-remifentanil general anaesthetic. Methods: With Ethics Committee approval and written informed consent, 40 healthy patients were premedicated with intravenous midazolam (0.05 mg kg-1) and ketoprofen (50 mg). They were then randomly allocated to receive either a combined sciatic-femoral nerve block with 25 mL mepivacaine 2% (15 mL for the femoral nerve, 10 mL for the sciatic nerve) (PNB group, n=20), or a general anaesthetic with a continuous intravenous infusion of remifentanil (0.1-0.3 mug kg-1 min-1) and propofol (target plasma concentration 2-4 mug mL-1) with a laryngeal mask airway (GA group, n=20). Results: The median (range) preparation time was 16 (10-28) min in the PNB group and 13 (8-22) min in the GA group (P=0.015). Ten PNB patients were directly discharged to the day-surgery unit after the procedure as compared with one GA patient (P=0.003). Discharge from the postanaesthesia care unit (PACU) required 5 (5-20) min in the PNB group and 23 (7-95) min in the GA group (P=0.001). Home discharge criteria were fulfilled after 277 (150-485) min in the PNB group and 170 (100-400) min in the GA group (P=0.005). Costs related to the time spent in the PACU were lower for the PNB group (Euro1.10, range Euro0-22) compared with the GA group (Euro30, range Euro0-176) (P=0.0005). There were no differences in total costs: PNB group Euro158 (range Euro105-194) versus GA group Euro160 (range Euro101-238) (P=0.61). Conclusions: In patients undergoing out-patient knee arthroscopy, the length of stay in the PACU can be shorter after a sciatic-femoral nerve block with a small volume of mepivacaine 2% compared with a propofol-remifentanil anaesthetic, and there is an increased likelihood that they will bypass the first phase of the postoperative recovery.