[Local anesthesia of the knee for arthroscopic surgery. Our experience in 1,000 cases]

We performed local anesthesia of the knee for arthroscopic surgery in 1,000 patients who were diagnosed of meniscopathy, chondropathy, or block of the knee. We established two anesthetic times. The first consisted of an intraarticular administration of 40 ml of a mixture containing bupivacaine 0.5%, lidocaine 0.5% or prilocaine 1%, and adrenaline 1:200,000. The second was extraarticular and consisted of a local infiltration at the sites of entrance of the arthroscope or instrumental material with lidocaine 0.5% or prilocaine 1%, with adrenaline 1:100,000. We kept a latency period of 10 to 15 min, time required for setting up the arthroscopic procedure. Ischemia was systematically avoided. With this technique the following surgical treatments were performed: meniscectomy, curettage of articular cartilage, synovectomy, plica sections, and extraction of free bodies. Tolerance to surgery was excellent in 32.3% cases, good in 46.5%, regular in 16%, and bad in 5.2%. In no cases more complex anesthetic techniques were undertaken. We conclude that the anesthetic technique used in this study is appropriate for arthroscopic surgery of the knee and allows to perform ambulatory surgery. The procedure is not useful in cases of ligament reconstruction, regional infection, and rupture of the articular capsula. Although the anesthetic technique is easy some factors should be considered before indication of the procedure such as a careful selection of the patient, skillfulness of the surgeon in performing the arthroscopy, and the accuracy of the preoperative diagnosis.