Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. A randomised controlled single-centre trial. University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

Operative Eingriffe werden zunehmend im ambulanten Sektor durchgeführt. Vielen Patienten wird eine Spinalanästhesie vorenthalten, obwohl sie eine Reihe von Vorteilen bietet. Durch innovative Formulierungen altbekannter Lokalanästhetika entstehen „neue“ Substanzen, die sich durch eine schnelle Anschlagszeit, eine kurze Wirkdauer, weniger Nebenwirkungen sowie eine geringe Inzidenz transienter neurologischer Symptome (TNS) ideal für ambulante Eingriffe eignen. Seit Kurzem sind die beiden Lokalanästhetika Prilocain 2% hyperbar und Chloroprocain 1% ohne Konservierungsmittel in Deutschland für die Spinalanästhesie zugelassen. Zusätzliche perioperative Maßnahmen, wie der Einsatz atraumatischer, dünner Spinalkanülen (z. B. 25G oder 27G), ein restriktives Flüssigkeitsregime und eine frühe Patientenmobilisierung, führen zu einer weiteren Reduktion von Nebenwirkungen. Die neue S1-Leitlinie der DGAI zur Durchführung der Spinalanästhesie bei ambulanten Patienten ermutigt uns Anästhesisten, dieses Verfahren zunehmend im ambulanten Bereich einzusetzen. More and more operative procedures are performed in an ambulatory setting. Many patients are denied spinal anaesthesia, although it provides several advantages. Innovative pharmaceutical formulations of well-tried local anaesthetics have created “new“ substances that are ideal for ambulatory surgery due to their fast onset, short duration of action, and very low incidence of complications such as transient neurological symptoms (TNS). Both hyperbaric prilocaine 2% and preservative-free chloroprocaine 1% were recently approved for spinal application in Germany. Additional perioperative measures, such as the use of atraumatic, thin spinal needles (25 or 27G), restrictive volume management, and early patient mobilisation, lead to a further reduction of complications. The new S1 guideline of the German Society of Anaesthesiology and Intensive Care Medicine encourages us anaesthetists to use spinal anaesthesia more frequently in an ambulatory setting.

Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s pre-existing conditions influence requirements. Methods: We analysed outcomes and influencing factors of fluid regimes in a retrospective cohort study including 90 severely burnt patients resuscitated with the same protocol. Results: The mean amount of fluids in the first 24 h was 6.5 mL/kg bodyweight (BW)/% total burn surface area (TBSA). A total of 14% received restrictive (6) mL/kgBW/%TBSA fluids. There was no difference regarding mortality, age, complications, organ failure, inhalation injury or full-thickness burns in the groups. Patients with excessive fluid therapy had a significantly lower ABSI score (9 vs. 11, p = 0.05) and TBSA (35 vs. 51%, p < 0.001), while patients with a restrictive fluid therapy needed fewer incidences of surgery to cover burn wounds (3.5 vs. 9.0 vs. 7.0, p = 0.008). History of liver disease or alcohol abuse tended to indicate excessive fluid administration. Patients with pre-existing heart failure received restrictive fluid therapy (23 vs. 3 vs. 4%, p = 0.03). Conclusions: Individualised, timely therapy monitoring is as essential as identifying patients with a higher or lower fluid requirement. Excessive fluid resuscitation had fewer deleterious consequences in complications than expected but seems to influence wound healing. Awareness of circumstances that prompt deviations from recommended fluid rates remains elementary.