Target-controlled total intravenous anesthesia associated with femoral nerve block for arthroscopic knee meniscectomy

The increased popularity of minimally invasive surgical techniques reduced recovery time of procedures that were usually associated with prolonged hospitalization. This study reports the technique of total intravenous anesthesia with propofol and remifentanil associated with femoral nerve block using the inguinal perivascular approach.

Ninety patients undergoing knee arthroscopy for meniscectomy were included in this study. Target-controlled infusion (TCI) of propofol (target = 4 microg.mL(-1)) and remifentanil (target = 3 ng.mL(-1)) was used for induction of anesthesia. The concentrations of propofol and remifentanil were changed according to the bispectral index (BIS) and mean arterial pressure (MAP). Volume-controlled mechanical ventilation with a laryngeal mask was used. The concentrations of propofol and remifentanil at the effector site, corresponding to the predictive concentrations, were obtained using the pharmacokinetic models of the drugs inserted in the TCI pumps. Time for hospital discharge encompassed the period between the moment the patient arrived at the recovery room and hospital discharge.

Maximal and minimal mean concentrations at the effector site (ng.mL(-1)) of remifentanil were 3.5 and 2.4, respectively. Maximal and minimal mean concentrations of propofol at the effector site (microg.mL(-1)) were 3.1 and 2.6, respectively. The mean flow of infusion of propofol and remifentanil was 8.54 mg.kg(-1).h(-1) and 0.12 microg.kg(-1).min(-1), respectively. Mean hospital discharge time was 180 min.

All patients were maintained within established parameters.