POSTER ABSTRACTS - ISAKOS

E-poster w/ Standard #823
An Evaluation of the Neurosensory Response of
Internal Structures of the Knee to Arthroscopic
Procedures with Femoral Nerve Block and
Intra-Articular Anesthesia
Tamiko Kamimura, Kamakura, JAPAN, Presenter
Masaki Shiono, MD, Kamakura, Kanagawa, JAPAN
Kunihiko Andoh, MD, Nagano, Nagano, JAPAN
Shonan Kamakura General Hospital, Kamakura,
Kanagawa, JAPAN
INTRODUCTION : Femoral nerve block (FNB) and
intra-articular anesthesia (IAA) are commonly
used for postoperative analgesia for anterior
cruciate ligament reconstruction. However, there
is no general consensus for using these anesthetic
procedures in arthroscopic surgery. In our study,
we used these anesthetic techniques for
outpatient knee arthroscopy and studied the
sensory impact on the intra-articular structures to
evaluate the effectiveness of these two methods.
MATERIALS & METHODS : We obtained informed
consent from all patients for FNB and IAA,
because these analgesic methods are not
commonly used for knee arthroscopic surgery.
Outpatient knee arthroscopy with FNB and IAA
was performed on 27 knees for 26 patients, all of
whom had clinical symptoms. The patients’ages
ranged from 16 to 79 years (mean 47.4). 27 knees
from 14 males and 13 knees from 12 females were
involved, consisting of 15 right and 12 left knees.
We performed the following arthroscopic
procedures: four examinations, two lavages, two
partial medial meniscectomies, one medial
meniscal repair, one rasping of medial meniscus,
one thermal shrinkage of medial meniscus, one
partial lateral meniscectomy, two subtotal
meniscectomies for lateral discoid meniscus,
three removals of free body, two plica resections,
three chondrectomies for medial femoral condyle
necrosis, four partial synovectomies and one
tumor resection.
We did not administer preoperative medication to
any patient, nor did we use an air tourniquet. At
the operating theatre all patients underwent FNB
with 10-15 cc 1% mepivacaine and IAA with 20cc
1% lidocaine and the arthroscopy started 20
minutes or more after injection. We made medial
and lateral infrapatellar portals for arthroscopy
and placed irrigation on the lateral suprapatellar
region without local anesthesia.
Normally, outpatient arthroscopic procedures
progress through three steps: arthroscopic
examination, diagnosis and surgery. All patients
received an explanation of their procedure and
shown the monitor throughout the surgery. We
rated their anxiety and discomfort levels using the
visual analogue scale (VAS; in which the max
score is 10) at the stage of palpation with the
probe at the anteromedial bundle of the anterior
cruciate ligament (ACLa), posterolateral bundle of
ACL (ACLp), anterior horn of medial meniscus
(MMa), posterior horn of medial meniscus (MMp),
anterior horn of lateral meniscus (LMa), posterior
horn of lateral meniscus (LMp) and
patellofemoral chondral surface (PF).
RESULTS : ACLa/ACLp: VAS scored 1-8 (mean
4.12) for the ACLa, 1-9 (mean 4.39) for the ACLp.
Eight knees that were diagnosed for ACL injury
scored ACLa 0-3 (mean 1.25), ACLp 1-7 (mean
3.0). 19 knees without ACL injury were ACLa 3-7
(mean 5.34), ACLp 3-9 (mean 4.97). There were
statistical differences between injured and noninjured
ACLs (p