الفهرس 
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Abstract
Ambulatory arthroscopic knee procedures have become increasingly common due to the effectiveness of the anaesthesia techniques that facilitate rapid and safe discharge. The minor invasivity of arthroscopic knee surgery requires alternative loco- regional techniques to general anaesthesia. The regional anaesthesia is less invasive, allows adequate anaesthesia, easy reproducibility, shorter hospital stay with a reduction in costs and satisfaction for surgeon, patient and anaesthesiologist.
The most common techniques used are unilateral spinal anaesthesia and combined sciatic- femoral and obturator nerve block, Ultrasound guided anaesthetic procedures have given a new life to traditional skills.
The non-invasive real-time imaging of the relevant anatomical structures with the needle is placed under direct vision and the spread of local anaesthetic can be seen within the potential space, with faster onset times, reduced doses of local anaesthetic, and higher and more predictable success rates, particularly in the more difficult cases, The increasing availability of small, high-resolution ultrasound and its utility in regional blocks has led a potential role in anaesthesia and pain management.
This study enrolled 32 consecutive patients (ASA) physical status I–II, 16 patients in each group scheduled to undergo elective arthroscopic knee surgery. All patients received premedication with 0.05 mg/kg midazolam intravenous injection.
(16) Patients received unilateral lumbar spinal block achieved by injecting 15 mg of 0.5% hyperbaric bupivacaine at the lumbar L3–L4 level through 25 gauge spinal needle plus 50 microgram fentanyl and (16) Patients received sciatic, femoral and obturator nerve blocks achieved using a 60 ml of 0.25% of bupivacaine guided by ultrasound.
The following Data was collected:
Demographic and clinical data, Hemodynamic changes, preparation time (Pt), surgical anaesthesia time (SAt), Nerve block quality, Onset and Degree of Block, intraoperative free movement of the knee joint, visual analogue scale (VAS), Total anaesthesia time (TAT), Time of first analgesia, Time-to-readiness for discharge (TRD), duration of surgery, time to-first spontaneous urination, adverse events as hypotension, bradycardia, arrhythmia, convulsion and post dural puncture headache.
group (A) showed shorter PT, SAT, more solid block and earlier discharge than group (b) who had longer total anaesthesia time, no adverse effect, shorter time for first urination, and more effective analgesia regarding VAS at 4, 6,8,10 hours post-operative.
Considering the possible side effects of the peripheral nerve block compared to spinal block and the experience of using ultrasound by the anaesthesiology team, ultrasound guided sciatic- femoral and obturator nerve block appear to be a good alternative to spinal anaesthesia for arthroscopic knee surgery.