Local Anesthetic Agents in Arthroscopy

Arthroscopy is performed with increasing frequency on a number of joints. In the lower limb the role of knee arthroscopy is well established with procedures enabling more accurate diagnosis and treatment of a myriad of conditions including but not being limited to meniscal injury and articular surface defects. Hip and ankle arthroscopy are less widely performed. However, despite this their use can be expected to increase as indications are better developed and techniques honed. While surgical technique often determines outcome in the long-term, analgesic control can significantly affect the patient’s satisfaction following a procedure as well as the overall acceptability of a procedure. Arthroscopic procedures in particular have enabled many procedures to be performed on a day case basis where as more traditional surgical interventions may have required at least an overnight hospital stay. This trend toward day case surgery also emphasizes the importance of optimum analgesic control. Traditionally intra-articular analgesic agents have been used following arthroscopic procedures as an augment to post-operative pain control. Classically these include the typical local anesthetic agents but also alternatives such as morphine. Recently however, the potential for deleterious effects of the intra-articular analgesics on the articular cartilage has been reported in a number of experimental studies, which has caused concern among practicing arthroscopic surgeons. The purpose of this chapter is to review the potential intra-articular analgesic agents used for pain control following lower limb arthroscopy and to also provide an up-to-date review of the evidence for the potential chondrotoxic effect of these agents.