Open Meniscectomy

Anesthesia Implications

Position: Supine, arms at side on armboards
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: High (7-10)
Tourniquet Use: Yes

High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.

Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2)

The menisci are cartilages that sit between the tibia and femur. There is the medial and lateral meniscus. Either one can be torn or damaged with intense physical activity. Most commonly, this happens by a twisting motion. This injury is very common in patients participating in contact sports. Mild injury (Grade I or II) are typically treated with anti-inflammatory medications, rest, and possible physical therapy. More severe injuries (Grade III) typically require a partial or total meniscectomy.

A large incision is made over the knee and the structures of the knee are exposed. The meniscus is examined and either partially or completely removed. The incision is then closed using staples or sutures