Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

Abstract

Background The choice of anesthesia plays a significant role in the success of total joint arthroplasty (TJA). Isobaric bupivacaine spinal anesthesia is often used. However, dosing of bupivacaine has not been extensively studied and is usually at the discretion of the treating anesthesiologist and surgeon. The goal of this study was to determine what, if any, effect the dose of bupivacaine spinal anesthesia had on perioperative outcomes in TJA. Methods A total of 761 TJAs performed with bupivacaine spinal anesthesia by arthroplasty surgeons were retrospectively reviewed. Perioperative outcomes evaluated were operation duration, estimated blood loss, length of stay (LOS) in the postanesthesia care unit, hospital LOS, discharge disposition, episodes of intraoperative hypotension, postoperative nausea and vomiting, and missed physical therapy sessions because of postoperative symptoms of hypotension. A Student’s t-test was used for continuous variables, and a chi-squared test was used for categorical variables. Results Of the 761 patients, 499 (65.6%) received 15 mg isobaric bupivacaine while 262 (34.4%) received <15 mg (range = 7.5-14.5 mg, median = 12.5 mg). With the numbers available in this cohort, lower doses of bupivacaine were not associated with any significant differences between groups for any of the studied perioperative outcomes, including proportion of patients discharged home or LOS. Conclusion Dosage of bupivacaine spinal anesthetic did not affect perioperative outcomes. Bupivacaine may not have a dose-related response curve in this regard, and if seeking to perform same-day or outpatient TJA, other agents may need to be considered, rather than smaller doses of bupivacaine.

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

“…Our subgroup analysis found no significant differences between high dose and low dose bupivacaine, which is consistent with other published literature [19]. In a retrospective review of 761 TJAs, Herndon et al found no significant differences in perioperative outcomes, including LOS and discharge disposition, when comparing 15 mg vs. <15 mg of isobaric bupivacaine [19]. While their study supports our data in finding no significant differences in surgical outcomes between high and low doses of bupivacaine, we suggest that the lowest possible therapeutic dose be used to mitigate risk of side effects.…”

“…Our subgroup analysis found no significant differences between high dose and low dose bupivacaine, which is consistent with other published literature [ 19 ]. In a retrospective review of 761 TJAs, Herndon et al .…”

“…Our subgroup analysis found no significant differences between high dose and low dose bupivacaine, which is consistent with other published literature [19]. In a retrospective review of 761 TJAs, Herndon et al found no significant differences in perioperative outcomes, including LOS and discharge disposition, when comparing 15 mg vs. <15 mg of isobaric bupivacaine [19].…”

“…found no significant differences in perioperative outcomes, including LOS and discharge disposition, when comparing 15 mg vs . <15 mg of isobaric bupivacaine [ 19 ]. While their study supports our data in finding no significant differences in surgical outcomes between high and low doses of bupivacaine, we suggest that the lowest possible therapeutic dose be used to mitigate risk of side effects.…”

Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty—Consecutive Case Series Study

“…It produces a well-known dose-dependent long-acting anaesthesia and analgesia, associated with postoperative urinary retention and delayed motor function recovery, which have led to multiple studies looking for a minimally effective dose, with non-compromising anaesthesia safety and fast-track protocols [ 3 , 4 ]. However, even lower doses of bupivacaine were not constantly associated with a significant improvement in the term of events, precluding the meeting of fast-track protocol requirements [ 5 ].…”