• Mladen Miskulin and Branka Maldini.
• Department of Orthopaedics, Sveti Duh General Hospital, Zagreb, Croatia.
• Arthroscopy. 2006 Sep 1;22(9):978-83.

PurposeTo investigate whether diclofenac could be used in preemptive and multimodal fashion with local anesthesia (LA) during arthroscopic knee surgery.MethodsA cohort of 628 patients (age range, 14 to 60 years) underwent outpatient arthroscopic knee surgery under LA with 15 mL of 2% lidocaine with epinephrine. Diclofenac 1 mg/kg was administered immediately before the procedure was performed. Pain was intraoperatively assessed with a 10-cm visual analogue scale (VAS). Patients' and surgeons' satisfaction with the quality of anesthesia was estimated by a special questionnaire and VAS score.ResultsFrom the technical point of view, arthroscopic procedures were successfully completed in 98.2% of patients. Pain experienced during injection of lidocaine (VAS score: median, 2.9; mean, 3.4; standard deviation [SD], 3.2; range, 0 to 10) was more severe (P = .0001) than pain experienced during the surgical procedure itself (VAS score: median, 1.8; mean, 2.4; SD, 2.2; range, 0 to 5.2). Arthroscopy was well tolerated by most patients (98.5%), and only 1.4% of procedures had to be terminated prematurely because of patient discomfort. Almost 95.7% of patients reported that they would undergo the same procedure again under the same type of anesthesia. In 4.7% of patients, LA was not considered optimal by the performing surgeon.ConclusionsArthroscopic knee surgery with diclofenac and LA with no premedication is an efficient and well-tolerated method used in outpatient practice with no major adverse effects.Level Of EvidenceLevel IV, therapeutic case series.

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