Mepivacaine Spinal Anesthesia Facilitates Rapid Recovery in Total Knee Arthroplasty Compared to Bupivacaine

Mahan, Meredith; Jildeh, Toufic R.; Tenbrunsel, Troy; Davis, Jason J.

doi:10.1016/j.arth.2018.01.009

Cited by 29 publications

(36 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there were no differences in operative duration and other adverse events. In addition, Mahan et al . (2018) reported that patients who underwent TKA with mepivacaine for spinal anesthesia had a shorter length of stay (28.1 ± 11.2 vs 33.6 ± 14.4 h, P = 0.002), fewer episodes of straight catheterization (3.8% vs 16.5%, P = 0.021) compared to bupivacaine, and exhibited no differences in postoperative pain or morphine consumption.…”

Section: Intraoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

217

165

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

show abstract

Section: Intraoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

217

165

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Since spinal anesthesia is attributed to less stress on the cardiopulmonary system, it has shown a decreased rate of adverse events compared with general anesthesia for joint replacement surgery. 3,[6][7][8][9] Due to the variations in longevity and complications from various spinal anesthetics, ideal short to intermediate length agents have been limited by historic complication rates. 3,[10][11][12][13][14][15][16][17] In the setting of ambulatory THA, an ideal anesthetic should provide anesthesia for the duration of the procedure along with efficient motor, sensory, and urinary function return.…”

mentioning

confidence: 99%

“…Unfortunately, the effects of the anesthetic have been reported to last between 3 and 9 hours. 3,10 Local anesthetics such as lidocaine and mepivacaine have been investigated as shorter-acting alternatives. Lidocaine was of great interest; however, its short length of action and reported 18% incidence of transient neurological symptoms (TNS) may not make it the ideal candidate for THA, 11 particularly in the lateral decubitus position.…”

mentioning

confidence: 99%

“…TNS are defined as new onset back pain or dysesthesia with radiation to the buttocks, hips, thighs, or calves occurring within the first 24 hours of surgery and lasting 2 to 3 days. 3,12,13 Mepivacaine, an intermediate-acting agent frequently used in the 1980s, demonstrated a decrease in use in the 1990s when several studies reported a high incidence of TNS, 3,14 although lower than lidocaine. Due to mepivacaine's intermediate duration of action (90-150 minutes), it stands to be an ideal candidate for an ambulatory practice, especially when one includes its decreased urinary retention profile.…”

mentioning

confidence: 99%

“…Due to mepivacaine's intermediate duration of action (90-150 minutes), it stands to be an ideal candidate for an ambulatory practice, especially when one includes its decreased urinary retention profile. 3,10,[14][15][16][17] Recent research has demonstrated its efficacy and benefits in total knee arthroplasty. 3 Therefore, it is reasonable to believe similar findings will occur in THA, but this has yet to be described.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Mepivacaine Spinal Anesthesia Facilitates Shorter Lengths of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine

Shaw

Mahan

Jabara

et al. 2020

The Journal of Hip Surgery

Self Cite

View full text Add to dashboard Cite

The purpose of this study was to compare the shorter-acting spinal anesthetic mepivacaine versus bupivacaine in total hip arthroplasty (THA). We retrospectively reviewed a prospectively collected database from a single surgeon's contemporary cohort of 311 consecutive patients undergoing primary THA. Primary outcomes were urinary retention, length of stay (LOS), neuraxial complications, pain control, and opioid consumption. Statistical analysis with univariate logistic regression was performed followed by a multivariate analysis controlling for multiple factors to evaluate the effect of anesthetic on primary outcomes. The univariate analysis demonstrated those with mepivacaine required less postoperative catheterization (0.0 vs. 5.7%, p = 0.009). Multivariate analysis exhibited that the mepivacaine group had a higher average opioid requirement (morphine equivalence [MEQ] 0.64 ± 0.22 vs. 1.17 ± 0.23; p < 0.001), similar average pain scores (visual analog scale 1.96 ± 0.24 vs. 2.65 ± 0.25), a lower LOS (0.90 ± 0.15 vs. 1.19 ± 0.15, p < 0.001), and an almost 10 times higher chance for a same-day discharge (odds ratio 9.67, 3.72–25.15, p < 0.001). There were no neuraxial complications in either group and no need for conversion to general anesthesia with the shorter-acting mepivacaine. Mepivacaine for spinal anesthesia with THA produced a significant improvement in recovery time with less urinary complications, a shorter LOS, and a higher chance of same-day discharge. Pain was well controlled in both groups with slightly increased pain and MEQ in the early postoperative period.

show abstract

Outpatient Unicompartmental Knee Arthroplasty

Sershon

Fricka

2019

Unicompartmental Knee Arthroplasty

View full text Add to dashboard Cite

Mepivacaine Spinal Anesthesia Facilitates Rapid Recovery in Total Knee Arthroplasty Compared to Bupivacaine

Cited by 29 publications

References 30 publications

Postoperative Pain Management in Total Knee Arthroplasty

Postoperative Pain Management in Total Knee Arthroplasty

Mepivacaine Spinal Anesthesia Facilitates Shorter Lengths of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine

Outpatient Unicompartmental Knee Arthroplasty

Contact Info

Product

Resources

About