Mepivacaine vs Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty at an Ambulatory Surgery Center

Calkins, Tyler E.; McClatchy, S. Gray; Rider, Carson M.; Toy, Patrick C.

doi:10.1016/j.arth.2021.07.014

Cited by 21 publications

(41 citation statements)

References 21 publications

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“…Further, this study found no significant differences in pain scores, complications, ED returns, or re-admissions [ 17 ]. However, bupivacaine was associated with a greater number of patients experiencing zero pain compared to the mepivacaine group [ 17 ]. Based on these studies and the results of our study, significant evidence demonstrating that mepivacaine facilitates faster ambulation and decreased length of stay exists.…”

Section: Discussionmentioning

confidence: 98%

“…Urinary retention occurrences and time to urination were also better with mepivacaine compared to bupivacaine (P=0.039) [11]. A study by Calkins et al evaluated spinal anesthesia in THA at an ambulatory surgery center (ASC) and found mepivacaine, when compared with bupivacaine, to be associated with less time in the ASC (P<0.001), decreased time to controlled voiding (P<0.001), and decreased time to ambulation (P<0.001) [17]. Further, this study found no significant differences in pain scores, complications, ED returns, or re-admissions [17].…”

Section: Discussionmentioning

confidence: 99%

“…A study by Calkins et al evaluated spinal anesthesia in THA at an ambulatory surgery center (ASC) and found mepivacaine, when compared with bupivacaine, to be associated with less time in the ASC (P<0.001), decreased time to controlled voiding (P<0.001), and decreased time to ambulation (P<0.001) [17]. Further, this study found no significant differences in pain scores, complications, ED returns, or re-admissions [17]. However, bupivacaine was associated with a greater number of patients experiencing zero pain compared to the mepivacaine group [17].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative outcomes of mepivacaine vs. bupivacaine in patients undergoing total joint arthroplasty with spinal anesthesia

et al. 2022

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Background Spinal anesthesia (SA) has been previously associated with improved outcomes after total joint arthroplasty (TJA). The purpose of this study was to compare outcomes between various local anesthetics. Methods This was a retrospective study of 1,328 patients undergoing primary TJA with SA from September 2020–2021 at a single institution. Patients were grouped based on TKA or THA and further separated and analyzed in terms of anesthetic agents—mepivacaine (M), hyperbaric bupivacaine (HB), or isobaric bupivacaine (IB). Subgroup analysis of same-day-discharge (SDD) patients and low- (<11 mg) and high-dose bupivacaine was performed. Statistical significance was assessed at P<0.05. Results Mepivacaine use was associated with younger age, lower ASAs, and lower Charlson Comorbidity Index (CCI) scores in both THAs and TKAs. Postoperatively, significant differences were found between HB, IB, and M in LOS, the first PT ambulation distance and rates of SDD, and home discharge in both THAs and TKAs. No significant differences in outcomes were observed between high- and low-dose bupivacaine in THAs or TKAs. In SDD patients, a significant difference was found only in the first 6-clicks mobility scores. After controlling for age, BMI, sex, ASA, and procedure type, mepivacaine was found to be associated with shorter LOS, increased likelihood of SDD, home discharge, POD-0 ambulation, and, further, the first ambulation distance. No significant differences were observed in 6-clicks mobility scores, urinary retention, 30-day ED returns or 30-day readmissions. Conclusions Both bupivacaine and mepivacaine are safe and effective local anesthetics for patients undergoing TJA as evidenced by low, similar rates of urinary retention and 30-day ED returns and readmissions. Mepivacaine does appeared to facilitate early ambulation, shorter LOS and home discharge and should be considered as the local anesthetic of choice for patients undergoing rapid recovery TJA.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative outcomes of mepivacaine vs. bupivacaine in patients undergoing total joint arthroplasty with spinal anesthesia

et al. 2022

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“…Two non-randomized studies included in this report were published in 2022 10 and 2021. 9 Both were retrospective cohort studies. One retrospective cohort study did not report follow-up findings after discharge, while 1 retrospective cohort study included follow-up times of 2 weeks, 6 weeks, and 3 months for applicable outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…6 Bupivacaine for arthroplasty can be given as a hyperbaric solution or isobaric solution in a spinal administration; the anesthesia onset is rapid (approximately 5 minutes) and has a typical duration of 3 to 9 hours, but can last up to 72 hours. [6][7][8][9] Hyperbaric bupivacaine solutions have a greater density than the cerebrospinal fluid, allowing for a quicker onset and shorter duration of motor and sensory block, whereas isobaric bupivacaine solutions have an equal density to the cerebrospinal fluid allowing for a slower onset and longer duration of action. 10 Mepivacaine is another common perioperative anesthesia indicated for local or regional anesthesia use.…”

Section: Context and Policy Issuesmentioning

confidence: 99%

Mepivacaine Versus Bupivacaine for Patients Undergoing Total Joint Arthroplasty

Hill¹,

Severn²,

Spry³

2022

cjht

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Mepivacaine was found to have statistically significantly better results than bupivacaine for various specific measurements related to neurologic symptoms, mobility, length of stay, urinary retention, and adverse events and safety; however, for the overall evidence, the difference in outcomes between the 2 did not consistently reach the level of statistical significance. The overall evidence for postoperative pain largely found no statistically significant difference between mepivacaine and bupivacaine, except for proportion of postoperative zero pain, where mepivacaine resulted in a statistically greater proportion of patients reporting zero pain postoperatively than bupivacaine. Evidence was only identified for individuals who received either total hip arthroplasty or total knee arthroplasty, and thus the findings presented in this report may not be generalizable to other total joint reconstruction or replacement surgeries. No evidence was identified regarding the cost-effectiveness or evidence-based guidelines for the use of mepivacaine versus bupivacaine for total joint arthroplasty.

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Mepivacaine Versus Bupivacaine for Spinal Anesthesia: A Systematic Review and Meta-analysis of Random Controlled Trials

et al. 2022

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Mepivacaine vs Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty at an Ambulatory Surgery Center

Cited by 21 publications

References 21 publications

Postoperative outcomes of mepivacaine vs. bupivacaine in patients undergoing total joint arthroplasty with spinal anesthesia

Postoperative outcomes of mepivacaine vs. bupivacaine in patients undergoing total joint arthroplasty with spinal anesthesia

Mepivacaine Versus Bupivacaine for Patients Undergoing Total Joint Arthroplasty

Mepivacaine Versus Bupivacaine for Spinal Anesthesia: A Systematic Review and Meta-analysis of Random Controlled Trials

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