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

Abstract

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.

Mepivacaine Versus Bupivacaine for Patients Undergoing Total Joint Arthroplasty

“…Two non-randomized studies included in this report were published in 2022 10 and 2021. 9 Both were retrospective cohort studies.…”

“…The mean dose and standard deviation for THA patients that received mepivacaine, hyperbaric bupivacaine, or isobaric bupivacaine was 63.4 (± 75.3) mg, 10.9 (± 1.7) mg, and 12.7 (± 2.1) mg, respectively. 10 The mean dose and standard deviation for TKA patients that received mepivacaine, hyperbaric bupivacaine, or isobaric bupivacaine was 65.2 (± 54.5) mg, 10.7 (± 1.6) mg, and 11.0 (± 2.4) mg, respectively. 10 The second retrospective cohort study 9 compared 2% mepivacaine (40 to 60 mg) to 0.75% hyperbaric bupivacaine (10.5 mg to 15 mg) for spinal anesthesia in THA.…”

“…10 The mean dose and standard deviation for TKA patients that received mepivacaine, hyperbaric bupivacaine, or isobaric bupivacaine was 65.2 (± 54.5) mg, 10.7 (± 1.6) mg, and 11.0 (± 2.4) mg, respectively. 10 The second retrospective cohort study 9 compared 2% mepivacaine (40 to 60 mg) to 0.75% hyperbaric bupivacaine (10.5 mg to 15 mg) for spinal anesthesia in THA.…”

“…[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. 11 It has a rapid onset of anesthesia (3 to 20 minutes), and a duration of 2 to 2.5 hours.…”

“…The objective, main outcome, patient characteristics, and interventions received were clearly described in both retrospective cohort studies. 9,10 One retrospective cohort study 10 described principal confounders and used multivariate linear and regression models to compare outcomes while controlling for confounders. The other retrospective cohort study 9 did not adequately describe principal confounders or control for confounders, but the authors noted that any confounding factors were unlikely to be significant.…”