Institutionen för kirurgisk vetenskap / Department of Surgical Science
Abstract
The aim of the present thesis was, to evaluate local anaesthesia as an
anaesthetic technique when performing knee arthroscopies, from a clinical
and economical point of view, and to describe the total costs for surgery
of knee injuries caused by sport activities in Stockholm.
In a retrospective study of 6519 arthroscopies, we tried to estimate the
failure rate for knee arthroscopy in local anaesthesia compared to the
same procedure in general anaesthesia. Failure was defined as a
rearthroscopy within 180 days due to persisting clinical symptoms.
Encouraged by the comparable results between local and general
anaesthesia in this study a prospective, randomized study including 400
patients was designed. Two hundred patients were randomized to local
anaesthesia, 100 patients to general anaesthesia and 100 to spinal
anaesthesia. Ninety percent of the patients who had local anaesthesia
were satisfied with the procedure. From the surgeon s point of view,
technical problems were experienced in 5% of the procedures in local
anaesthesia. Arthroscopy in local anaesthesia should be avoided if the
patient has excessive synovitis. The results of the study led to the
conclusion that elective knee arthroscopy can be performed under local
anaesthesia in the majority of the patients.
Furthermore the cost saving for an arthroscopy in local anaesthesia was
SEK 1 011 per procedure compared to an arthroscopy in general or spinal
anaesthesia with our described setup. The total hospital stay for
patients was significantly lower for patients with local anaesthesia
compared to both general and spinal anaesthesia. To determine health care
costs for sports related knee surgery, we used data from three different
databases an insurance company database including all players in the
studied sports (football, floor ball, European team handball and ice
hockey), the hospital patient record database and data from a county
database containing information about all surgical procedures performed
in Stockholm. The average knee surgery cost for all studied players in
the population was SEK 108 in 1997.
In conclusion, arthroscopy with local anaesthesia was an anaesthetic
technique with clinical results comparable to other methods like general
or spinal anaesthesia. Furthermore local anaesthesia was more cost and
time effective. The total health costs for the community was low for
players in football, floor ball, European team handball and ice hockey
when their knee injuries were surgically treated