Shoulder arthroscopy with the use of local anesthesia

In recent years shoulder arthroscopy has become increasingly used. To simplify the procedure and to minimize cost and operative risks, a study has been conducted to evaluate the use of local anesthesia for diagnostic shoulder arthroscopy. Two groups of patients were studied. The first group of 17 patients was examined while the patients were under general anesthesia, but a continuous infusion of lidocaine-chloride 0.2% was also performed. Serial blood samples were obtained. In all patients the peak serum level of local anesthetic was below the toxic levels. Seventeen other patients were operated on while they were under local anesthesia; 20 ml 1% prilocaine-epinephrine was injected into the soft tissues on the posterior aspect of the shoulder, and a continuous infusion of 0.2% lidocaine-chloride was infused intraarticularly during the procedure. In addition, adjunctive diazepam was used in eight patients. Three patients could not complete the procedure because of pain. We conclude that the absorption pattern of local anesthetic from the shoulder joint during arthroscopy is within the acceptable dose range. However, performing diagnostic shoulder arthroscopy with the patient under local anesthesia is a demanding procedure for the patient and may not always be possible.