Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 7:11:6-9.
doi: 10.1016/j.artd.2021.05.020. eCollection 2021 Oct.

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

Carl L Herndon  1 , Matthew M Levitsky  1 , Chimere Ezuma  1 , Nana O Sarpong  1 , Roshan P Shah  1 , H John Cooper  1
Affiliations

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

Carl L Herndon et al. Arthroplast Today. .

Abstract

Background: The choice of anesthesia plays a significant role in the success of total joint arthroplasty (TJA). Isobaric bupivacaine spinal anesthesia is often used. However, dosing of bupivacaine has not been extensively studied and is usually at the discretion of the treating anesthesiologist and surgeon. The goal of this study was to determine what, if any, effect the dose of bupivacaine spinal anesthesia had on perioperative outcomes in TJA.

Methods: A total of 761 TJAs performed with bupivacaine spinal anesthesia by arthroplasty surgeons were retrospectively reviewed. Perioperative outcomes evaluated were operation duration, estimated blood loss, length of stay (LOS) in the postanesthesia care unit, hospital LOS, discharge disposition, episodes of intraoperative hypotension, postoperative nausea and vomiting, and missed physical therapy sessions because of postoperative symptoms of hypotension. A Student's t-test was used for continuous variables, and a chi-squared test was used for categorical variables.

Results: Of the 761 patients, 499 (65.6%) received 15 mg isobaric bupivacaine while 262 (34.4%) received <15 mg (range = 7.5-14.5 mg, median = 12.5 mg). With the numbers available in this cohort, lower doses of bupivacaine were not associated with any significant differences between groups for any of the studied perioperative outcomes, including proportion of patients discharged home or LOS.

Conclusion: Dosage of bupivacaine spinal anesthetic did not affect perioperative outcomes. Bupivacaine may not have a dose-related response curve in this regard, and if seeking to perform same-day or outpatient TJA, other agents may need to be considered, rather than smaller doses of bupivacaine.

Keywords: Perioperative outcomes; Spinal anesthesia; Total hip arthroplasty; Total knee arthroplasty.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Comparison of preoperative patient characteristics between the group of patients who received 15 mg of bupivacaine and those who received less than 15 mg. Bold values signify statistical significance.
Figure 2
Figure 2
Comparison of intraoperative metrics between the group of patients who received 15 mg of bupivacaine and those who received less than 15 mg. Bold values signify statistical significance.
Figure 3
Figure 3
Comparison of perioperative metrics between the group of patients who received 15 mg of bupivacaine and those who received less than 15 mg.
See this image and copyright information in PMC

References

    1. Sloan M., Premkumar A., Sheth N.P. Projected volume of primary total joint arthroplasty in the US, 2014 to 2030. JBJS. 2018;100(17):1455. - PubMed
    1. Gaffney C.J., Pelt C.E., Gililland J.M., Peters C.L. Perioperative pain management in hip and knee arthroplasty. Orthop Clin. 2017;48(4):407. - PubMed
    1. Karlsen A.P.H., Geisler A., Petersen P.L., Mathiesen O., Dahl J.B. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015;156(1):8. - PubMed
    1. Chang C.-C., Lin H.-C., Lin H.-W., Lin H.-C. Anesthetic management and surgical site infections in total hip or knee replacement a population-based study. Anesthesiology. 2010;113(2):279. - PubMed
    1. Davis F., Laurenson V., Gillespie W., Wells J., Foate J., Newman E. Deep vein thrombosis after total hip replacement. A comparison between spinal and general anaesthesia. J Bone Joint Surg Br. 1989;71(2):181. - PubMed

LinkOut - more resources