Spinal anesthesia as a method of anesthetic support for arthroscopic cruciate ligament reconstruction: a single-center prospective cohort study

Background: The annually increasing number of arthroscopic interventions on cruciate ligaments, especially in outpatient settings, necessitates identifying the most rational methods of anesthetic support for such procedures.

Aim: To evaluate spinal anesthesia (SA) as the method of choice for anesthetic support in arthroscopic cruciate ligament reconstruction.

Materials and methods: This single-center prospective cohort study included 52 patients who underwent arthroscopic cruciate ligament reconstruction under SA. Postoperative outcomes were assessed by measuring pain intensity at rest and during movement at 4, 8, 12, 16, 20, and 24 hours postoperatively using the visual analog scale (VAS). The need for opioid analgesics, their total dose, time to the first analgesic request, motor block recovery time (Bromage scale to Bromage-1), and time to first ambulation were recorded. Intraoperative hemodynamic and pulse oximetry parameters, SA performance time, duration of anesthesia and surgery, total dose of non-steroidal anti-inflammatory drugs (NSAIDs) during hospitalization, complications, adverse anesthesia reactions, and hospital stay duration were also evaluated. Additionally, patient satisfaction with anesthesia and postoperative pain management quality was assessed.

Results: Significant differences in pain levels at rest and during mobilization were observed (p <0.001, R=0.8). A total of 82.6% (n=43) of patients required opioid analgesics postoperatively, with 18% (n=8) needing administration twice or more. The frequency of opioid use was directly proportional to pain severity (p <0.001, R=0.7). The first request for analgesics occurred, on average, at 178 minutes, with motor block recovery at 134 minutes. First ambulation was recorded, on average, more than 3 hours after surgery.

Conclusion: Severe postoperative pain, the inability to achieve early mobilization, adverse anesthesia effects, and the transition of arthroscopic procedures to “day surgery” status emphasize the need for alternative anesthesia techniques that overcome SA shortcomings and provide prolonged postoperative pain relief.