Mepivacaine Spinal Anesthesia Facilitates Shorter Lengths of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine

The purpose of this study was to compare the shorter-acting spinal anesthetic mepivacaine versus bupivacaine in total hip arthroplasty (THA). We retrospectively reviewed a prospectively collected database from a single surgeon's contemporary cohort of 311 consecutive patients undergoing primary THA. Primary outcomes were urinary retention, length of stay (LOS), neuraxial complications, pain control, and opioid consumption. Statistical analysis with univariate logistic regression was performed followed by a multivariate analysis controlling for multiple factors to evaluate the effect of anesthetic on primary outcomes. The univariate analysis demonstrated those with mepivacaine required less postoperative catheterization (0.0 vs. 5.7%, p = 0.009). Multivariate analysis exhibited that the mepivacaine group had a higher average opioid requirement (morphine equivalence [MEQ] 0.64 ± 0.22 vs. 1.17 ± 0.23; p < 0.001), similar average pain scores (visual analog scale 1.96 ± 0.24 vs. 2.65 ± 0.25), a lower LOS (0.90 ± 0.15 vs. 1.19 ± 0.15, p < 0.001), and an almost 10 times higher chance for a same-day discharge (odds ratio 9.67, 3.72–25.15, p < 0.001). There were no neuraxial complications in either group and no need for conversion to general anesthesia with the shorter-acting mepivacaine. Mepivacaine for spinal anesthesia with THA produced a significant improvement in recovery time with less urinary complications, a shorter LOS, and a higher chance of same-day discharge. Pain was well controlled in both groups with slightly increased pain and MEQ in the early postoperative period.

A Review of Neuraxial Epidural Morbidity

Background The true incidence of serious neuraxial complications such as epidural hematoma or abscess after postoperative epidural infusions is still uncertain, in part due to inconsistencies in multicenter data collection. Methods Prospective data were collected over 16 yr from the authors' Acute Pain Service, which is based in a large tertiary teaching institution with a nonobstetric general surgical population. Results Over this period, 8,210 epidural catheters were inserted for postoperative analgesia and 32 computed tomography or magnetic resonance imaging scans were undertaken to exclude potential neuraxial complications. From these, two spinal hematomas (1:4,105) and six epidural abscesses (1:1,368) were diagnosed. Only one patient required surgical decompression. There were no long-term neurologic sequelae in any patient. In the past 6 yr, the frequency of investigation and diagnosis of epidural abscess has increased. Overall, the combined rate of epidural abscess or hematoma was 1:1,026, (0.1%; 95% confidence interval, 0.04-0.19%) with a need for operative intervention of 1:8,210 (0.01%; 95% confidence interval, 0.0-0.07%). Conclusions Spinal hematoma was very rare (&lt; 0.05%). Epidural abscess was also rare (&lt; 0.1%) but remains a potentially serious complication. Early diagnosis, using magnetic resonance imaging in patients with appropriate clinical indicators, before the onset of neurologic signs, enables conservative therapy in many cases and may help to prevent the development of serious neurologic sequelae.