Mepivacaine spinal anesthesia facilitates rapid recovery in total knee arthroplasty compared to bupivacaine

To date, Mepivacaine is not used as a spinal anaesthetic in the total knee arthroplasty (TKA) for rapid recovery.

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Key take away

Over the years, bupivacaine has been known to be a standard anesthetic agent due to its notable reliability. However, its duration of action, up to 3-9 hours may be too long for modern total knee arthroplasty (TKA). Therefore, there is a requirement for an ideal spinal anesthetic agent. The results of the current study demonstrated that mepivacaine for spinal anesthesia with TKA had adequate duration to complete the surgery and facilitated a more rapid recovery with less urinary complications and a shorter length of stay.

Background

To date, Mepivacaine is not used as a spinal anaesthetic in the total knee arthroplasty (TKA) for rapid recovery. The analysis aims to compare the spinal Bupivacaine vs Mepivacaine as postoperative measures among the patients going through primary TKA.

Method

A total of 156 consecutive patients who went through primary TKA were administered with either Bupivacaine (n = 53) or Mepivacaine (n = 103). The length of stay, opioid consumption, distance associated with physical therapy, urinary retention, and pain control were considered as the primary outcomes. The determination of the anaesthesia impact with primary results was done by applying statistical analysis with univariate logistic regression.

Result

Patients went through TKA with Mepivacaine had fewer episodes of straight catheterisation and a shorter length of stay than Bupivacaine. The Mepivacaine group showed moderately greater VAS pain scores and morphine consumption in the postanesthesia care unit, apart from that showed no variation in VAS scores or morphine consumption afterwards. Neither Mepivacaine nor Bupivacaine required to convert general anaesthesia or transient neurologic symptom complication.

Conclusion

TKA with Mepivacaine provides adequate duration to complete the surgery and promote a shorter length of stay and a more rapid recovery with less urinary complications. No transient neurologic symptoms or severe pain was noticed in the Mepivacaine group afterwards.