Cost-effectiveness Analysis Of General Anesthesia With LMA And Subarachnoid Block During Knee Arthroscopy In Ambulatory Patient

Objectives:The purpose of this study is to compare the cost-effectiveness of spinal anaesthesia and general anaesthesia using LMA in ambulatory patients undergoing knee arthroscopy.Methods:30 ASAⅠandⅡpatients,aged between 18-65 years old,scheduled for ambulatory knee arthroscopy were randomizedly divided into two groups.In the SA group,subarachnoid block was achieved with 9 mg bupivacaine,while the GA group received a general anaesthesia with LMA and sevoflurane.Postoperatively,both groups were monitored in PACU until they met the discharge standards of ambulatory patients undergoing spinal or general anaesthesia.Operating room turnover times of anaesthesia(exclusive of operation time),PACU recovery times,and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction.Statistical analysis was performed with analysis of variance and X.We regarded all the economic cost of each anaesthesia as the cost,and the discharge of this patients as the effect,that we can work out a cost-effectiveness ratio of each group.At last we compared the cost-effectiveness ratios of the 2 groups,as well as the side-effect rates,the VAS pain scores and satisfaction degrees,to draw a conclusion that which kind of anaesthesia is better for the ambulatory knee arthroscopy patients.Results:There were no significant differences between patients of Group SA and Group GA regarding age,sex,ASA grade and the kinds of knee arthroscopy surgeries. Group SA had a longer PACU recovery time(SA:241±74 min,GA:37±15 min,P =0.00)and a lower total anaesthesia cost(SA:726.6±3.1 RMB,GA:1683.2±61.5 RMB,P=0.00) than Group GA.While Group GA has a shorter room turnover time of anaesthesia(SA:22.4±2.3 min,GA:12.3±1.9 min,P=0.00) and a better patient satisfaction(P=0.009).VAS pain scores did not differ in both groups(P=0.489). There were no anesthetic failures or serious adverse events in either group.The anaesthesia-associated side-effect rates was more frequent in Group SA than in Group GA(SA:46.7%,GA:0%,P=0.006).Conclusion:For ambulatory patients undergoing knee arthroscopy,spinal anesthesia with bupicaine is an cost-effective alternative,but is associated with a longer discharge time and increased side effects.While general analgesia with LMA can provide a shorter peri-operative time and a better patient satisfaction,but cost a little higher.