BACKGROUND We evaluated pain during arthroscopic knee surgery performed under local anesthesia, with respect to various types of lesions and specific procedures used. METHODS Arthroscopic surgery was performed on 63 joints (61 patients), with a median age of 49 years. We asked the patients to describe the pain experienced at each step of the procedure, and to compare the level of pain experienced at the time of injection and during the operation, using a visual analog scale (VAS). RESULTS Pain experienced at the time of injection of the local anesthetic was more severe than the pain experienced during the surgical procedure. Local anesthesia provided good pain control during partial resection of the meniscus, chondroplasty, and removal of free bodies. Patients sometimes experienced more pain during treatment of the suprapatellar pouch, including the plica and the anterior cruciate ligament. CONCLUSIONS Injection of the local anesthetic was usually the most painful phase of the entire procedure. Patients were generally satisfied with the pain control.