Outcomes of Patients Undergoing Total Knee Arthroplasty with Spinal Anesthesia: A Comparison of Mepivacaine versus Bupivacaine

Introduction:Previous literature indicates that mepivacaine used for spinal anesthesia may lead to reduced recovery time and urinary retention compared to bupivacaine in patients undergoing total knee arthroplasty (TKA). We sought to compare outcomes between spinal anesthetics in our high-volume joi...

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Bibliographic Details
Published in:Journal of arthroscopy and joint surgery 2022-07, Vol.9 (3), p.114-121
Main Authors: Holbert, Samuel Elliott, Brennan, Jane, Bahethi, Shreeya, Mandich, Madilyn, Cheema, Minahil, Turcotte, Justin J., Macdonald, James, King, Paul
Format: Article
Language:English
Subjects:
Joint replacement surgery
Urinary retention
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Summary:Introduction:Previous literature indicates that mepivacaine used for spinal anesthesia may lead to reduced recovery time and urinary retention compared to bupivacaine in patients undergoing total knee arthroplasty (TKA). We sought to compare outcomes between spinal anesthetics in our high-volume joint institution.Materials and Methods:A retrospective review of 553 unilateral primary TKA patients who received spinal anesthesia was conducted. Patients were divided by their receipt of mepivacaine or bupivacaine. Univariate comparisons before and after propensity score matching were used to compare outcomes for TKA patients receiving mepivacaine with those who did not.Results:Of the 553 patients, 102 received mepivacaine, and 451 received bupivacaine. After propensity score matching, patients who received bupivacaine experienced longer lengths of stay, received more oral morphine milligram equivalents (OMMEs), and were less likely to be discharged home. No differences in rates of nausea, urinary retention, or 30-day readmissions were observed between the groups.Discussion:In patients undergoing TKA with a spinal anesthesia, after adjusting for potentially confounding factors using propensity score matching, the use of mepivacaine was associated with shorter length of stay, less overall OMME requirements, and increased likelihood of home discharge, with no increase in complication rates. Based on these results, mepivacaine appears to be a viable alternative to bupivacaine for use in TKA rapid recovery protocols.
ISSN:2542-6001
2214-9635
DOI:10.4103/jajs.jajs_84_22