Orthopedic Institute of Central Jersey, A Division of Ortho Alliance NJ, Manalapan, NJ; Hackensack Meridian School of Medicine, Department of Orthopedic Surgery, Nutley, NJ; Hackensack Meridian Health, Jersey Shore University Medical Center, Department of Orthopedic Surgery, Neptune, NJ.
Hackensack Meridian School of Medicine, Department of Orthopedic Surgery, Nutley, NJ.
J Arthroplasty. 2022 Jul;37(7):1396-1404.e5. doi: 10.1016/j.arth.2022.03.031. Epub 2022 Mar 17.
Mepivacaine is an intermediate acting amide local anesthetic that can be used for neuraxial anesthesia in total joint arthroplasty (TJA) with a shorter duration of action (1.5-2 hours) compared to the more commonly used local anesthetic bupivacaine. The purpose of this study was to perform a systematic review and meta-analysis comparing bupivacaine and mepivacaine spinal anesthesia during elective TJA and the surgical outcomes of the time to full neurologic motor return, pain, mobility, length of stay (LOS), and complications including transient neurologic symptoms and urinary function.
PubMed, Ovid MEDLINE, and Ovid Embase were screened for "arthroplasty, spinal anesthesia, bupivacaine, and mepivacaine," in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 159 studies were screened and 5 studies were evaluated. Data were compared regarding motor function return, mobility (distance ambulated), pain (visual analog scale [VAS]), LOS, and postoperative complications.
Full-text screening yielded 5 studies (3 randomized controlled trials and 2 retrospective cohort studies), with a total of 1,550 patients. Mepivacaine spinals had an earlier return to motor function (154 minutes vs 170 minutes, 95% CI: [-31.6, -0.9], P = .04), shorter LOS (25.95 hours vs 29.96 hours, 95% CI: [-6.8, -1.2], P = .01), and decreased urinary retention (7.15% vs 10.58%, 95% CI: [-6.3%, -0.6%], P = .02) with no differences in pain (VAS 3.57 vs 3.68, 95% CI: [-2.1, 1.9], P = .90) or distance ambulated (94.2 ft vs 89.1 ft, 95% CI: [-15, 25.2], P = .60) compared to bupivacaine spinal anesthesia.
The method of anesthesia administration has been an increasing area of focus for quicker and safer recovery to allow for early ambulation and facility discharge. The rapid recovery facilitated by mepivacaine may further enable outpatient TJA and enhance patient recovery.
III.
甲哌卡因是一种中效酰胺类局部麻醉剂，可用于全关节置换术（TJA）的脊神经麻醉，其作用持续时间较短（1.5-2 小时），与更常用的局部麻醉剂布比卡因相比。本研究旨在进行系统评价和荟萃分析，比较布比卡因和甲哌卡因在择期 TJA 中的脊神经麻醉以及神经运动功能完全恢复、疼痛、活动度、住院时间（LOS）和并发症（包括短暂神经症状和尿功能障碍）的手术结果。
根据系统评价和荟萃分析的首选报告项目，在 PubMed、Ovid MEDLINE 和 Ovid Embase 中筛选了“关节成形术、脊神经麻醉、布比卡因和甲哌卡因”的研究。共筛选了 159 项研究，其中 5 项研究进行了评估。比较了运动功能恢复、活动度（步行距离）、疼痛（视觉模拟评分[VAS]）、LOS 和术后并发症的数据。
全文筛选出 5 项研究（3 项随机对照试验和 2 项回顾性队列研究），共纳入 1550 例患者。甲哌卡因脊麻起效更快（154 分钟 vs 170 分钟，95%CI：[-31.6，-0.9]，P=.04），住院时间更短（25.95 小时 vs 29.96 小时，95%CI：[-6.8，-1.2]，P=.01），尿潴留发生率更低（7.15% vs 10.58%，95%CI：[-6.3%，-0.6%]，P=.02），而疼痛（VAS 3.57 vs 3.68，95%CI：[-2.1，1.9]，P=.90）或步行距离（94.2 英尺 vs 89.1 英尺，95%CI：[-15，25.2]，P=.60）与布比卡因脊麻无差异。
麻醉给药方式一直是快速、安全恢复的重点关注领域，以实现早期活动和出院。甲哌卡因的快速恢复可能进一步实现门诊 TJA，并促进患者康复。
III 级。
