Newly Published
Perioperative Medicine  |   July 2020
Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesiology, Sidney Kimmel Medical College (E.S.S., J.D.S., M.S.A., S.A.B., W.J.H., A.J.C., J.J.L., C.S.W., J.L.B., M.C.T.) and the Department of Physical Therapy (A.C.N.), Thomas Jefferson University (A.M.M.), Philadelphia, Pennsylvania; United Anesthesia Services, Plymouth Meeting, Pennsylvania (V.P.K.); Rothman Orthopaedics, Philadelphia, Pennsylvania (M.S.A., S.A.B., W.J.H.); and the Department of Physical Therapy, Rothman Orthopedic Specialty Hospital, Bensalem, Pennsylvania (E.E.C.).
  • A portion of this work was accepted for presentation at the Spring 2020 meeting of the American Society of Regional Anesthesia and Pain Medicine, which was postponed due to the COVID-19 pandemic.
    A portion of this work was accepted for presentation at the Spring 2020 meeting of the American Society of Regional Anesthesia and Pain Medicine, which was postponed due to the COVID-19 pandemic.×
  • Submitted for publication February 10, 2020. Accepted for publication June 30, 2020.
    Submitted for publication February 10, 2020. Accepted for publication June 30, 2020.×
  • Correspondence: Address correspondence to Dr. Schwenk: Sidney Kimmel Medical College at Thomas Jefferson University, 111 South 11th Street, 8290 Gibbon Building, Philadelphia, Pennsylvania 19107. Eric.Schwenk@jefferson.edu. Anesthesiology’s articles are made freely accessible to all readers on www.anesthesiology.org, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pharmacology / Regional Anesthesia
Perioperative Medicine   |   July 2020
Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation: A Randomized Controlled Trial
Anesthesiology Newly Published on July 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003480
Anesthesiology Newly Published on July 23, 2020. doi:https://doi.org/10.1097/ALN.0000000000003480
Abstract

Background: Early ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.

Methods: This randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, or 12.5 mg of isobaric bupivacaine for spinal anesthesia. The primary outcome was ambulation between 3 and 3.5 h. Secondary outcomes included return of motor and sensory function, postoperative pain, opioid consumption, transient neurologic symptoms, urinary retention, intraoperative hypotension, intraoperative muscle tension, same-day discharge, length of stay, and 30-day readmissions.

Results: Of 154 patients, 50 received mepivacaine, 53 received hyperbaric bupivacaine, and 51 received isobaric bupivacaine. Patient characteristics were similar among groups. For ambulation at 3 to 3.5 h, 35 of 50 (70.0%) of patients met this endpoint in the mepivacaine group, followed by 20 of 53 (37.7%) in the hyperbaric bupivacaine group, and 9 of 51 (17.6%) in the isobaric bupivacaine group (P < 0.001). Return of motor function occurred earlier with mepivacaine. Pain and opioid consumption were higher for mepivacaine patients in the early postoperative period only. For ambulatory status, 23 of 50 (46.0%) of mepivacaine, 13 of 53 (24.5%) of hyperbaric bupivacaine, and 11 of 51 (21.5%) of isobaric bupivacaine patients had same-day discharge (P = 0.014). Length of stay was shortest in mepivacaine patients. There were no differences in transient neurologic symptoms, urinary retention, hypotension, muscle tension, or dizziness.

Conclusions: Mepivacaine patients ambulated earlier and were more likely to be discharged the same day than both hyperbaric bupivacaine and isobaric bupivacaine patients. Mepivacaine could be beneficial for outpatient total hip arthroplasty candidates if spinal is the preferred anesthesia type.

Editor’s Perspective:

What We Already Know about This Topic:

  • Early ambulation after total hip arthroplasty is key to achieving readiness for discharge

  • The spinal anesthetic for total hip arthroplasty that balances pain control with timely resolution of motor block has not been identified

What This Article Tells Us That Is New:

  • In this randomized, three-arm study involving 154 patients, more individuals in the mepivacaine spinal group ambulated 3 to 3.5 h after injection than did individuals in either the isobaric or hyperbaric bupivacaine group

  • Likewise, more patients in the mepivacaine group achieved same-day discharge than patients in the other experimental groups