The Sooner Hip Replacement Patients Can Get Up and Walk after Surgery, the Faster They Can Recover at Home

Spinal anesthesia with the drug mepivacaine allows for earlier ambulation after total hip arthroplasty than either form of the more commonly used drug bupivacaine, according to findings from researchers at Thomas Jefferson University Hospital in Philadelphia, PA.

Andrew Mendelson, Jordan Smoker, Vincent Kasper, William Hozack, Matthew Austin, Scot Brown, Alyson Nemeth, Eric Czerwinski, Johnathan Li, Alexa Cohen, Jamie Baratta, Chris Wahal, Marc Torjman, and Eric Schwenk received a Best of Meeting Abstract Award for their abstract of the study, “Early Ambulation After Hip Arthroplasty: A Double-Blind, Randomized, Controlled Trial,” which was accepted for the 45th Annual Regional Anesthesia and Acute Pain Medicine Meeting. The meeting was scheduled for April 23-25 but was cancelled due to COVID-19. 

The sooner patients can walk after surgery, the faster they can be discharged, allowing for more comfortable recovery at home, lower overall cost of care, and increased availability of critical hospital resources. Although spinal anesthesia offers several advantages over general anesthesia, it also limits sensory and motor function when blocking nerves and may delay patients’ ability to ambulate.

One of the most commonly used drugs for spinal anesthesia is bupivacaine, a long-acting amide local anesthetic available in several forms, including hyperbaric and isobaric. Both of those forms can produce partial motor blockade for 2.5–3 hours. Mepivacaine, an intermediate-acting amide local anesthetic, produces reliable spinal anesthesia for 1.5–2 hours, and studies with total knee arthroplasty suggested that it allows for earlier postsurgical ambulation than bupivacaine.

Mendelson et al. performed a prospective, randomized, double-blind trial comparing mepivacaine to hyperbaric and isobaric bupivacaine in 154 patients receiving spinal anesthesia during total hip arthroplasty to determine which drug allows for earlier ambulation. They found that patients who received mepivacaine were more likely to ambulate at 3.5 hours than those who received either form of bupivacaine. The mepivacaine group also had significantly shorter length of stay and more same-day discharges than patients in the other two groups. However, patients receiving mepivacaine had higher pain ratings and opioid consumption—but only in postanesthesia care unit. No other differences existed among the groups, including incidence of transient neurologic symptoms.

“Patients who received mepivacaine spinal anesthesia were more likely to ambulate early and be discharged on the day of surgery, and mepivacaine spinal anesthesia should be considered in appropriate outpatient total hip arthroplasty candidates,” Mendelson et al. concluded.

ASRA serves the clinical and professional educational needs of physicians and scientists, ensuring excellence in patient care through regional anesthesia and pain medicine, and investigating the scientific basis of the specialty.

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