Chapter 7. Conclusions

1. The immediate recovery profile of general anaesthesia with propofol infusion and isoflurane or desflurane inhalation was smooth with low levels of pain and nausea, and home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Patients anaesthetised with isoflurane or propofol were more sedated in the early recovery period than patients anaesthetised with desflurane. Patients anaesthetised with spinal 5% lidocaine had the lowest sedation score.

2. General anaesthesia with isoflurane or desflurane was more cost-effective than spinal anaesthesia with 5% lidocaine in ambulatory knee surgery if a short recovery unit time was needed. Propofol anaesthesia was the most expensive anaesthesia method compared to isoflurane, desflurane or 5% spinal anaesthesia.

3. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively, and it continued to be low in propofol, 5% spinal, desflurane and isoflurane anaesthesias during the first postoperative week. The patients were highly satisfied with knee surgery done on an ambulatory basis. There was a slight tendency to favour general anaesthesia compared to spinal anaesthesia in the questionnaires returned after one week postoperatively.

4. Home readiness after 2% lidocaine spinal anaesthesia was significantly longer (almost 45 min) than home readiness after sevoflurane inhalation anaesthesia. Sevoflurane was more cost-effective than spinal anaesthesia with 2% lidocaine if a short PACU time was needed. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia.

Isoflurane inhalation anaesthesia was the cheapest anaesthetic method compared to general anaesthesias with desflurane, sevoflurane, propofol and 2% and 5% lidocaine spinal anaesthesias in adult ambulatory knee surgery.