Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: mepivacaine vs bupivacaine in a randomized controlled trial

Abstract

Background Mepivacaine as an intermediate-length spinal anesthetic for rapid recovery in total knee arthroplasty (TKA) has not been fully described. We compared spinal mepivacaine vs bupivacaine for postoperative neurologic function in patients undergoing primary TKA. Methods Thirty-two patients undergoing primary TKA were enrolled. Primary outcome measure was return of motor and sensory function. Secondary outcome measures included assessment of urinary function, pain via visual analog scale (VAS) scores, opioid usage, distance walked and pain with physical therapy, time to discharge readiness, and complications. Results Patients with mepivacaine spinal anesthetic had faster return of sensory function (164 ± 38.6 vs 212 ± 54.2 minutes, P = .015), return of motor function (153 ± 47.4 vs 200 ± 45.2 minutes, P = .025), and time to straight leg raise (148 ± 43.5 vs 194 ± 50.8 minutes, P = .023). The mepivacaine group experienced significantly fewer episodes of urinary retention and shorter time to urination (344 ± 154.4 vs 416 ± 96.3 minutes, P = .039). Patients exhibited slightly higher VAS pain scores in the postanesthesia care unit (1.0 ± 1.7 vs 2.7 ± 2.3, P = .046) with no difference in opioid consumption. There were no differences in VAS scores or opioid use on the inpatient ward. Patients achieved discharge readiness 71 minutes faster in the mepivacaine group. There was no need to convert to general anesthesia or transient nerve symptoms in either group. Conclusions Patients undergoing TKA with mepivacaine spinal anesthetic had a reliably more rapid neurologic recovery after TKA compared to bupivacaine.

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

“…The results of our study are in alignment with prior studies, demonstrating that mepivacaine use is associated with earlier ambulation, increased same-day discharge, and decreased length of stay [ 2 , 11 ]. Schwenk et al .…”

“…While our study did not evaluate pain scores specifically, our finding that mepivacaine patients were more likely to ambulate POD0 and ambulate further suggests that any increased levels of early postoperative pain may not be clinically significant enough to impact early recovery. In another small randomized controlled trial comparing 32 patients receiving either bupivacaine or mepivacaine, significant differences were found in return to sensory function ( P =0.015) and return of motor function ( P =0.025), both favoring mepivacaine [ 11 ]. Urinary retention occurrences and time to urination were also better with mepivacaine compared to bupivacaine ( P =0.039) [ 11 ].…”

“…In another small randomized controlled trial comparing 32 patients receiving either bupivacaine or mepivacaine, significant differences were found in return to sensory function ( P =0.015) and return of motor function ( P =0.025), both favoring mepivacaine [ 11 ]. Urinary retention occurrences and time to urination were also better with mepivacaine compared to bupivacaine ( P =0.039) [ 11 ]. A study by Calkins et al .…”

“…Another study used a double-blind, randomized clinical trial to investigate the effects of mepivacaine and bupivacaine on a patient’s return to motor function following total hip and knee arthroplasty and found a mean time of 26 minutes sooner with mepivacaine [ 3 ]. Mepivacaine has not only been shown to shorten time to ambulation and length of stay, but also has a faster neurological recovery when compared to bupivacaine [ 11 ].…”

Mepivacaine Versus Bupivacaine in Adult Surgical Patients: A Meta-analysis, Trial Sequential Analysis of Randomized Controlled Trials

“…Finally, seven references were included in our meta-analysis. [23][24][25][26][27][28][29] The references screening process is shown in Figure 1.…”