Mepivacaine or Ropivacaine for Same-Day Surgery?

Does one anesthesia for outpatient joint arthroplasty surgery outshine another?

Researchers at Brigham and Women’s Hospital in Boston compared two spinal anesthetics—mepivacaine and ropivacaine—in a retrospective study. Their work, “Optimizing Spinal Anesthesia In Same-Day Discharge Knee Arthroplasty Patients: Mepivacaine vs. Ropivacaine,” was published in the July 12, 2022 edition of The Journal of Arthroplasty.

Co-author David Evans, M.D., explained to OTW how crucial the right anesthesia is to a successful outpatient total joint arthroplasty: “The standard anesthesia has been bupivacaine with recent literature showing short-acting anesthetics may be better. Therefore, we felt it would be impactful to compare two of the more commonly used short-acting anesthetics to see if one was advantageous over the other in facilitating quicker discharge, as this has not been studied.”

The team looked at 172 patients who underwent unicompartmental knee arthroplasty (UKA) and 35 who had total knee arthroplasty (TKA) from May 2018 to December 2020 at one institution and were discharged the same day.

The investigators found no significant difference in discharge times between patients receiving mepivacaine vs. ropivacaine for UKA (202 minutes vs. 218 minutes) or TKA (193 minutes vs. 196 minutes.

Dr. Evans told OTW, “For total and unicompartmental knee replacement discharge times were similar between mepivacaine and ropivacaine for spinal anesthesia. Future work may involve comparing to other procedures such as total hip arthroplasty, as well as use in larger populations and comparing other spinal anesthetics such as chloroprocaine, etc.”