Administration of Low-dose Hyperbaric Bupivacaine for Spinal Anesthesia in the Setting of Outpatient Arthroplasty.
Journal
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
ISSN: 2474-7661
Titre abrégé: J Am Acad Orthop Surg Glob Res Rev
Pays: United States
ID NLM: 101724868
Informations de publication
Date de publication:
01 May 2024
01 May 2024
Historique:
received:
27
10
2023
accepted:
29
03
2024
medline:
10
5
2024
pubmed:
10
5
2024
entrez:
9
5
2024
Statut:
epublish
Résumé
With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty. Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge. Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population. Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile.
Identifiants
pubmed: 38722907
doi: 10.5435/JAAOSGlobal-D-23-00240
pii: 01979360-202405000-00009
doi:
Substances chimiques
Bupivacaine
Y8335394RO
Anesthetics, Local
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.
Références
Singh JA, Yu S, Chen L, Cleveland JD: Rates of total joint replacement in the United States: Future projections to 2020-2040 using the national inpatient sample. J Rheumatol 2019;46:1134-1140.
Munnich EL, Parente ST: Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Aff (Millwood) 2014;33:764-769.
Memtsoudis SG, Sun X, Chiu YL, et al.: Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology 2013;118:1046-1058.
Ferreira AC, Hung CW, Ghanta RB, Harrington MA, Halawi MJ: Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: Propensity-matched analysis of a national surgical quality database. Arthroplasty (London, England) 2023;5:7.
Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ: Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. The J Bone Joint Surg Am Vol 2013;95:193-199.
Basques BA, Toy JO, Bohl DD, Golinvaux NS, Grauer JN: General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am 2015;97:455-461.
Calkins TE, Johnson EP, Eason RR, Mihalko WM, Ford MC: Spinal versus general anesthesia for outpatient total hip and knee arthroplasty in the ambulatory surgery center: A matched-cohort study. The J Arthroplasty 2023;S0883-5403:01212-01213.
Yap E, Wei J, Webb C, Ng K, Behrends M: Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: A multicentered cohort study. Reg Anesth Pain Med 2022;47:294-300.
Paziuk TM, Luzzi AJ, Fleischman AN, et al.: General vs spinal anesthesia for total joint arthroplasty: A single-institution observational review. J Arthroplasty 2020;35:955-959.
Johnson RL, Kopp SL, Burkle CM, et al.: Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: A systematic review of comparative-effectiveness research. Br J Anaesth 2016;116:163-176.
Warren J, Sundaram K, Anis H, et al.: Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg 2020;28:e213-e221.
Kendall MC, Cohen AD, Principe-Marrero S, Sidhom P, Apruzzese P, De Oliveira G: Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: A national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol 2021;21:226.
Baratta JL, Schwenk ES: Regional versus general anesthesia for ambulatory total hip and knee arthroplasty. Curr Opin Anaesthesiol 2022;35:621-625.
Zaric D, Pace NL: Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev 2009:CD00300610.1002/14651858.CD003006.pub3.
doi: 10.1002/14651858.CD003006.pub3
Frisch NB, Darrith B, Hansen DC, Wells A, Sanders S, Berger RA: Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty. Arthroplasty Today 2018;4:236-239.
Berde C, Koka A, Drasner K: Local anesthetics Basics Of Anesthesia. Elsevier, 2018, 139-155.
Uppal V, Retter S, Shanthanna H, Prabhakar C, McKeen DM: Hyperbaric versus isobaric bupivacaine for spinal anesthesia: Systematic review and meta-analysis for adult patients undergoing noncesarean delivery surgery. Anesth Analg 2017;125:1627-1637.
Loubert C, Hallworth S, Fernando R, et al.: Does the baricity of bupivacaine influence intrathecal spread in the prolonged sitting position before elective cesarean delivery? A prospective randomized controlled study. Anesth Analg 2011;113:811-817.
Chen M, Chen C, Li L: Effect of baricity of bupivacaine on median effective doses for motor block. Med Sci Monitor 2017;23:4699-4704.
DeCook CA: Outpatient joint arthroplasty: Transitioning to the ambulatory surgery center. J Arthroplasty 2019;34:S48-S50.
Chen M, Chen C, Ke Q: The effect of age on the median effective dose (ED50) of intrathecally administered plain bupivacaine for motor block. Anesth Analg 2014;118:863-868.
Sia AT, Tan KH, Sng BL, Lim Y, Chan ESY, Siddiqui FJ: Use of hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2013:CD005143.
Mahan MC, Jildeh TR, Tenbrunsel T, Adelman BT, Davis JJ: Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: Mepivacaine vs bupivacaine in a randomized controlled trial. Arthroplasty Today 2019;5:226-233.
Schwenk ES, Kasper VP, Smoker JD, et al.: Mepivacaine versus bupivacaine spinal anesthesia for early postoperative ambulation: A randomized controlled trial. Anesthesiology 2020;133:801-811.
Luck JF, Fettes PDW, Wildsmith JAW: Spinal anaesthesia for elective surgery: A comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth 2008;101:705-710.