Choice of spinal anesthesia key to early ambulation after THA

Mepivacaine (MEP) spinal anesthesia allows for earlier ambulation for patients undergoing total hip arthroplasty (THA) compared with the more commonly used bupivacaine, according to a study accepted for the Regional Anesthesia & Acute Pain Medicine Meeting, which was canceled due to COVID-19.

Andrew Mendelson, M.D., from Thomas Jefferson University Hospital in Philadelphia, and colleagues analyzed data for 154 patients undergoing primary elective THA who could walk 10 feet without human assistance. Patients were randomly assigned to mepivacaine (MEP; 50 patients), isobaric bupivacaine (IB; 49 patients), or hyperbaric bupivacaine (HB; 55 patients).

The researchers found that the greatest percentage of patients met the primary endpoint of ambulation at 3.5 hours after spinal placement in the MEP group, followed by the HB and then IB groups. Patients randomly assigned to MEP were more likely to ambulate at 3.5 hours versus those who received HB (odds ratio [OR], 4.1; P = 0.001) or IB (OR, 10.4; P < 0.001). The MEP group had significantly shorter length of stay compared with the HB and IB groups (18.5 hours versus 26.0 and 26.8 hours, respectively; P = 0.005), and more patients in the MEP group were discharged the day of surgery (44.9 percent versus 24.1 and 22.4 percent, respectively; P = 0.026). However, patients in the MEP group had significantly higher pain ratings and opioid consumption in the postanesthesia care unit compared with patients in the other groups.

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