Disclosures: Calkins reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
August 16, 2021
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Mepivacaine spinal anesthesia led to faster same-day discharge after THA vs bupivacaine

Disclosures: Calkins reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
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Compared with bupivacaine spinal anesthesia, mepivacaine allowed for faster same-day discharge from an ASC with a minor increase in pain for patients undergoing total hip arthroplasty.

In a recently published study, Tyler E. Calkins, MD, and colleagues retrospectively reviewed data on 282 consecutive patients (mean age of 55.7 years) who underwent anterior-approach THA at an ASC from November 2018 to July 2020. Researchers compared length of stay, same-day discharge (SDD), time to controlled urinary voiding, ambulation, postoperative pain scores and complications between patients who received mepivacaine (n = 141) vs. bupivacaine (n = 141) for spinal anesthesia.

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The researchers noted all THAs were done with the direct anterior approach with the patient supine. Data were derived Calkins TE, et al. J Arthroplasty. 2021;doi:10.1016/j.arth.2021.07.014.

Calkins and colleagues found that compared with bupivacaine, mepivacaine “safely facilitated more rapid SDD from the ASC through decreased times to controlled void and ambulation with only minor increase in pain when compared to bupivacaine,” they wrote in the study.

The mepivacaine group had a mean length of stay of 4 hours, a time to void of 3.1 hours and time to ambulation of 3.2 hours, while the bupivacaine group had a mean length of stay of 5.7 hours, a time to void of 4.9 hours and time to ambulation of 4.5 hours. However, researchers noted the mepivacaine group had a mean postoperative pain score of 1.7 and 1.1 at 2 hours after surgery and at discharge, respectively, while the bupivacaine group had a mean postoperative pain score of 0.9 and 0.5 at 2 hours after surgery and at discharge, respectively.

“While interpreting these results, it should be remembered that all THAs were done with the direct anterior approach with the patient supine in a single, high-volume surgeon’s practice at [two] privately owned ASCs,” Calkins and colleagues wrote. “These results may differ from THAs done through a posterior approach,” they added.