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Knee block anesthesia for arthroscopic procedures

AORN Journal, July, 2005 by Connie Archer Sargent, M. Tim Dunfee

Patients have numerous anesthetic choices when undergoing outpatient knee arthroscopy procedures. General, spinal, and epidural anesthesia and peripheral (eg, sciatic, femoral) nerve blocks all can be used. Knee block anesthesia is a regional/ local soft tissue and field block (ie, joint space) anesthetic choice that is recommended by surgeons, anesthesia care providers, and nursing staff members at Bronson Methodist Hospital, Kalamazoo, Mich. Knee block anesthesia for arthroscopic knee procedures, although used infrequently at many facilities, is effectively used at Bronson Methodist Hospital to provide long-lasting pain control and control intraoperative bleeding. The technique is not technically demanding and has minimal risk of complications. Perioperative staff members at this facility

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prefer the knee block technique because it is easy to perform, is safe for the patient, and does not require induction of general anesthesia. Furthermore, patients usually can move without requiring additional lifting by perioperative staff members.

Knee block anesthesia has the potential of saving approximately $700 per patient in this facility because surgery and recovery time are decreased. In addition, patients have been pleased with the procedure and the outcome. At a conference in Washington, DC, researchers indicated that more than 90% of patients who previously had undergone knee block anesthesia would choose this form of anesthesia for future knee arthroscopy procedures. (4)

HISTORY

Knee block anesthesia was initiated at Bronson Methodist Hospital in 1984. Studies performed at that time demonstrated that serum lidocaine levels during knee block anesthesia were well within safety tolerance. (5,6) A prospective study found the technique to be effective, well tolerated by patients, and well accepted by physicians and nurses. (5)

This technique has been used on a wide range of age groups from teenagers to octogenarians. It is an appropriate anesthetic choice for many patients who are classified in anesthesia risk classes I, II, or III, and occasionally class IV. Often, this is the anesthetic of choice for patients with compromised cardiac or pulmonary status because of the safety of the anesthetic. Knee block anesthesia is the anesthetic of choice for transarthroscopy surgery at this facility because of the minimal systemic effect of the local anesthetic medications used for this procedure and the ability to titrate or eliminate sedative medications. Local anesthesia may not be appropriate for certain patients, however, because of psychological factors or the acute nature of an injury.

Members of an anesthesia group that covers four of the five health care facilities in Kalamazoo routinely use knee block anesthesia. During the past 21 years, most orthopedic surgeons who practice at one or more of these facilities have used knee block anesthesia for arthroscopic procedures, including

* lateral retinacular release and articular cartilage work (eg, chondroplasty, drilling of bone lesions);

* meniscal work (eg, repail, partial excision);

* removal of loose bodies;

* spur excision, and

* synovectomies.

Anterior cruciate ligament reconstruction procedures with knee block anesthesia are not performed at Bronson Methodist Hospital because this form of anesthesia only blocks the joint and soft tissue rather than underlying bone that is further down at the insertion point of the anterior cruciate ligament.

Perioperative nurses play an important role in collaboration with surgeons, anesthesia care providers, and other hospital personnel in preparing and screening patients. Together they determine if knee block anesthesia is the best option.

PROCEDURE PREFERENCE CARDS

For knee block anesthesia to be successful, it is vital that both the anesthesia care provider and surgeon accept and are committed to using this technique. At Bronson Methodist Hospital, procedure preference cards were prepared collaboratively by anesthesia care providers, orthopedic surgeons, and nurses. To ensure optimal patient outcomes, it was important to put the needs of the surgeons and anesthesia care providers in writing before procedures were performed.

ORTHOPEDIC SURGEONS' PREFERENCE CARDS.

The preoperative department has large preference cards in plastic sheet protectors, which display a diagram of a knee (Figure 1). There is a card for each surgeon who performs arthroscopic procedures with instructions depicting where he or she intends to insert the arthroscopic cannulas. These were designed so that surgeons could provide anesthesia care providers with specific instructions regarding where the local anesthetic should be injected. Typically, injections for three portals are needed, but some orthopedic surgeons use only two portals. The nurse places the card in an easily visible spot so the anesthesia care provider can refer to it before he or she administers the block.

[FIGURE 1 OMITTED]

ANESTHESIA CARE PROVIDER CARDS, A preoperative nurse worked with each anesthesia care provider to develop his or her own preference card (Table 1). Nurses use these cards to determine what sedating medications each anesthesia care provider prefers to help make the patient comfortable during the procedure and also what medications the anesthesia care provider injects for knee block anesthesia; therefore, each card has some variations. The card includes the anesthesia care provider's glove size and any other special requests that the anesthesia care provider may have. These cards also may be used for ankle, axillary, and other peripheral anesthesia blocks that the anesthesia care provider may perform.

Health Care Industry

Knee block anesthesia for arthroscopic procedures

AORN Journal, July, 2005 by Connie Archer Sargent, M. Tim Dunfee

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