The Perioperative Management of Ambulatory Knee Surgery

Purpose of the Review: is to provide evidence-based, UpToDate anesthetic and analgesic management of ambulatory knee patients. Recent Findings: Although administering general anesthesia with or without nerve blocks is common, these procedures can be done under neuroaxial or surgical regional anesthesia and be discharged on the same day. Nerve blocks are invaluable in facilitating quick discharge due to their analgesic and opioid-sparing effect. Continuous femoral nerve block provided the best analgesic benefit and opioid-sparing effect. Combining single-injection femoral sciatic nerve blocks provides the most consistent analgesic benefits compared with all other techniques but will most likely impair postoperative function. Summary: Anterior cruciate ligament reconstruction, patellar ligament and fractures, and meniscus injuries are common injuries that requires surgical repair. Surgery is often done on an outpatient basis. Anesthesia and good pain management should facilitate rapid recovery and faster discharge.Minimizing the use of opioids is the cornerstone of management, as there is a tendency toward opioid abuse in this age group. Multimodal analgesia that includes regional anesthesia has shown a benefit. Continuous femoral nerve block, showed the best benefit contrary to studies from a few years ago that showed no value of regional anesthesia. Adductor canal, sciatic nerve blocks, infiltration between the popliteal artery and posterior capsule of the knee (iPACK) or local anesthetic infiltration, have important analgesic roles and opioid-sparing effect. Postoperative recovery and rehabilitation may take a long time for the patient to return to their athletic activities.