Dust Off the Mepivacaine for Knee Arthroplasty Anesthesia

Formerly Discredited Spinal Anesthetic Promotes Faster Postsurgical Recovery

Findings from 2 studies conducted at Henry Ford Health System conclude that a long-shelved anesthetic agent may be a preferred choice for management of pain from knee replacement surgery. Researchers report that mepivacaine provided comparable pain relief with fewer side effects than the more commonly used spinal anesthetic, bupivacaine. Specifically, patients who received mepivacaine were found to regain normal function faster after surgery, resulting is shorter hospital stays. Senior author Jason Davis, MD, a joint replacement surgeon at Henry Ford, commented, “Our studies suggest that mepivacaine has multiple advantages and few drawbacks compared to bupivacaine as a spinal anesthetic in knee replacement surgery. It shows promise as an ideal anesthetic by working long enough for most knee replacements without the excessive duration that can delay patients’ recovery.” The findings from one of the studies were published in Journal of Arthroplasty.

Prior research had indicated that mepivacaine was associated with a higher risk for postsurgical complications that include nerve irritation. But those findings have been refuted by more recent studies that point to faster return of nerve function with mepivacaine than with bupivacaine. The Henry Ford Health studies included a retrospective review of records from 156 patients who underwent knee replacement surgery, and a small randomized study of 32 patients to assess the rapidity of nerve recovery, both for movement and for urinary control. Patients treated with mepivacaine recorded better outcomes on all these measures than those treated with bupivacaine.

Read a news story about the findings.

The journal abstract may be read here.

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