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Resident PGY 1
Henry Ford Hospital
Background: The purpose of this study was to compare the shorter-acting spinal anesthetic mepivacaine versus bupivacaine in total hip arthroplasty (THA). Methods: We retrospectively reviewed a prospectively collected database from a single surgeon’s contemporary cohort of 312 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. Results: The univariate analysis demonstrated those with mepivacaine had a shorter LOS (0.9 ± 0.7 vs 1.3 ± 0.7 days, P < .001) and fewer required postoperative catherization (0.0% vs 5.7%, P = .009). Patients administered mepivacaine had slightly higher visual analog scale pain scores and morphine equivalence per hour (MEQ) in the postanesthesia care unit (2.2 ± 2.5 vs 0.8 ± 1.6, P < .001; 2.6 ± 3.3 vs 0.9 ± 2.1 equivalents/hour, P < .001). Multivariate analysis exhibited that the mepivacaine group had a higher average MEQ (0.64 ± 0.22 vs. 1.17 ± 0.23; P < .001), a lower LOS (0.90 ± 0.15 vs. 1.19 ± 0.15, P < .001), and an almost 10 times higher chance for a same-day discharge (odds ratio 9.67, 3.72-25.15, P < .001). There were no neuraxial complications in either group and no need for conversion to general anesthesia with the shorter-acting mepivacaine. Conclusion: 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.
Shaw, Jonathan; Mahan, Chad; Jabara, Justin; and Davis, Jason J., "Mepivacaine Spinal Anesthesia Facilitates Shorter Length of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine" (2019). Clinical Research. 18.