JOA - 2026-05-01 - Journal Article; Observational Study
Lidocaine-Bupivacaine Spinal Proves Safe and Effective in Outpatient Total Joint Arthroplasty.
Forlenza EM, Shaw J, Potluri AS, O'Reilly K, Mehta NA, Berger RA
Topics
Key Takeaway
A lidocaine-bupivacaine spinal mixture achieved 0% TNS incidence with mean motor block resolution at 198 minutes and discharge readiness at 359 minutes across 208 outpatient TJA cases.
Summary Depth
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Summary
This prospective observational study evaluated the safety and efficacy of a fixed-dose spinal combining 2 mL of 2% isobaric lidocaine and 0.7 mL of 0.5% bupivacaine with propofol sedation in outpatient primary THA, TKA, and UKA. TNS incidence was 0%, nausea occurred in 6.1%, urinary retention in 1.6%, and mean VAS on PACU arrival was 3.0. Motor block resolved at 198 minutes, ambulation was achieved at 235 minutes, and discharge criteria were met at 359 minutes, with THA patients ambulating latest at 321 minutes versus UKA at 226 minutes.
Key Limitation
The absence of a control arm with standard single-agent spinal (hyperbaric bupivacaine or hyperbaric lidocaine) makes it impossible to determine whether the 0% TNS rate and 359-minute discharge time represent an improvement over existing alternatives.
Original Abstract
BACKGROUND
The utilization of spinal anesthetics has been integral to the implementation of rapid recovery protocols, which allow for same-day discharge following total joint arthroplasty (TJA). The purpose of this investigation was to determine the safety and efficacy of a single-dose spinal containing a mixture of lidocaine and bupivacaine in the setting of outpatient TJA.
METHODS
A prospective observational study was analyzing patients undergoing elective, outpatient, primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) receiving a single-shot spinal consisting of a mixture of two mL of 2% isobaric lidocaine and 0.7 mL of 0.5% bupivacaine along with titrated propofol sedation. The incidence of complications, including transient neurological symptoms (TNS), the length of motor blockade, time to ambulation, and time to discharge, were recorded. The final cohort included 208 patients, of whom 47 underwent THA, 145 underwent TKA, and 16 underwent UKA.
RESULTS
There were 6.1% of patients who experienced nausea, of which less than half experienced vomiting (2.9%), 1.6% of patients experienced urinary retention, and 0% of patients experienced transient neurological symptoms. The ability to perform plantarflexion and dorsiflexion of the ankle was consistently regained first (198.3 minutes), followed by the ability to begin ambulating (235.0 minutes), then by sensation to the dorsum of the foot (310.0 minutes), and lastly, criteria for discharge (359.0 minutes). The ability to ambulate was regained first by patients undergoing UKA (226.2 minutes), followed by TKA (235.6 minutes) and then THA (321.0 minutes). Visual analog score (VAS) pain scores upon arrival to the post-anesthesia care unit (PACU) averaged 3.0 across all groups.
CONCLUSIONS
A spinal anesthetic containing a mixture of lidocaine and bupivacaine proved safe and effective, with a mean duration of action of 198 minutes, without compromising rapid recovery protocols or same-day discharge.