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
. 2025 Aug 7;37(1):33.
doi: 10.1186/s43019-025-00283-4.

Retrospective comparison of chloroprocaine and mepivacaine in spinal anesthesia for same-day discharge TKA

Noah Gilreath  1   2 , Jonathan Liu  3 , Cameron Thomson  3 , Mohammad Daher  3 , Sandi Caus  3 , Harrison Dunn  3 , Valentin Antoci Jr  4   3 , Thomas Barrett  4   3 , Eric Cohen  4   3
Affiliations

Retrospective comparison of chloroprocaine and mepivacaine in spinal anesthesia for same-day discharge TKA

Noah Gilreath et al. Knee Surg Relat Res. .

Abstract

Introduction: Chloroprocaine is a rapid, short-acting spinal anesthetic that may facilitate quicker postoperative recovery in total knee arthroplasty (TKA). However, limited literature exists regarding its use in patients undergoing same-day discharge (SDD) TKA. This study evaluated the clinical outcomes and safety of chloroprocaine compared with those of mepivacaine.

Methods: This retrospective study of 178 patients who underwent primary TKA at a single ambulatory surgery center from March 2022 to June 2023 compared chloroprocaine (n = 114) and mepivacaine (n = 64) spinal anesthesia. Surgical outcomes, including estimated blood loss (EBL), operative time, discharge time, 90-day emergency department visits, and 90-day readmissions, were evaluated. In addition, anesthesia-related complications such as hypotension, bradycardia, urinary retention, and postanesthesia care unit (PACU) outcomes were recorded. Continuous variables between the chloroprocaine and mepivacaine groups were compared via independent sample t-tests, whereas categorical variables were analyzed via chi-squared tests. A p-value of less than 0.05 was considered statistically significant.

Results: There were no differences in the baseline characteristics between the two groups. The chloroprocaine group had a significantly shorter operative time (73.1 versus 84.9 min, p < 0.001) and faster discharge (3.7 versus 4.2 h, p < 0.001), with no difference in EBL. Patients in the chloroprocaine group had a lower incidence of urinary retention (2.5 versus 15.6%, p = 0.004), a lower proportion of patients who needed a urinary catheter (2.6 versus 14.1%, p = 0.004), and fewer postoperative complaints of numbness (19.3 versus 39.1%, p = 0.004). There were no differences in surgical complications.

Conclusions: Compared with mepivacaine, chloroprocaine spinal anesthesia for SDD TKA was associated with lower rates of urinary retention, a reduced need for urinary catheterization, fewer neurological complaints in the PACU, and faster discharge times. No differences were observed in surgical outcomes between the groups, and there were no instances of unplanned direct admissions. These results suggest that chloroprocaine can be safely used as a reliable alternative to mepivacaine in outpatient TKA.

Keywords: Length of stay; Perioperative outcomes; Same-day discharge; Short-acting spinal anesthesia; Total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Lifespan Hospital System (no. 1803063) on 4 April 2022, with the need for written informed consent waived. Consent for publication: Not applicable. Competing interests: All the other authors declare that they have no conflicts of interest.

Similar articles

See all similar articles

References

    1. Moucha CS, Weiser MC, Levin EJ (2016) Current strategies in anesthesia and analgesia for total knee arthroplasty. JAAOS J Am Acad Orthop Surg 24(2):60 - PubMed
    1. Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ (2013) Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am 95(3):193–199 - PubMed
    1. Owen AR, Amundson AW, Fruth KM, Duncan CM, Smith HM, Johnson RL et al (2022) Spinal compared with general anesthesia in contemporary primary total hip arthroplasties. J Bone Joint Surg Am 104(17):1542–1547 - PubMed
    1. Lamo-Espinosa JM, Mariscal G, Gómez-Álvarez J, Benlloch M, San-Julián M (2024) Causes and risk factors for same-day discharge failure after total hip and knee arthroplasty: a meta-analysis. Sci Rep 14(1):12627 - PMC - PubMed
    1. Auyong DB, Allen CJ, Pahang JA, Clabeaux JJ, MacDonald KM, Hanson NA (2015) Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthroplast 30(10):1705–1709 - PubMed

LinkOut - more resources