Introduction Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine, we aimed to assess the impact on postanesthesia care unit (PACU) recovery in a quaternary care, academic medical center.
Methods In this quality improvement retrospective study, a single surgeon performed 96 combined total knee and hip arthroplasties booked as same-day discharge from September 20, 2021 to December 20, 2021. Starting on November 15, 2021 the subarachnoid block was performed with isobaric mepivacaine 37.5–45 mg instead of hyperbaric bupivacaine 9–10.5 mg. We compare these cohorts for time to discharge from PACU, perioperative oral morphine milligram equivalent (OMME) administration, PACU pain scores, conversion to general anesthesia (GA), and overnight admission.
Results We found the use of isobaric mepivacaine as compared with hyperbaric bupivacaine for intrathecal block in same-day discharge total joint arthroplasty was associated with decreased length of PACU stay at our academic center (median 4.03 vs 5.33 hours; p=0.008), increased perioperative OMME (mean 22.5 vs 11.4 mg; p<0.001), increased PACU pain scores (mean 6.29 vs 3.41; p<0.01) and no difference in conversion to GA or overnight admission.
Conclusions Intrathecal mepivacaine was associated with increased perioperative OMME consumption and PACU pain scores, but still realized a decreased PACU length of stay.
- REGIONAL ANESTHESIA
- Ambulatory Care
- Outcome Assessment, Health Care
- Pain, Postoperative
Data availability statement
No data are available.
Data availability statement
The Institutional Review Board exempted status of this project is contingent on limited access to the deidentified data set.
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Contributors KDM had the initial idea for the project and directed its early stages. PWC and TU performed data gathering, literature review and wrote the manuscript. VK performed the data analysis, described the statistical methods in the manuscript and supplied the figures. PWC serves as guarantor. All authors had a significant role in editing and finalizing the manuscript.
Funding University of Colorado Department of Anesthesiology SEED Grant.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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