spinal cocktail for arthroplasties?

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xenon2000

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I'm a resident in a busy academic medical center with a few ortho attendings who run private-practice-esque high-turnover, protocolized arthroplasty rooms every day. Our anesthesia attendings seem to use the standard bupiv out of the kit + 0.1-0.2 of duramorph, but rarely deviate from this (except one who uses isobaric bupiv for "faster and denser" block). Thinking ahead to when I may be doing a lot of arthroplasties in PP, I'm curious to know what everyone's favorite spinal cocktail is for TKAs + THAs? Any secrets to success?

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No spinal narcotics on TKAs when they get a block. Which virtually all of our TKAs do.
I love isobaric spinals but no longer use them for medico legal reasons. Switched to hyperbaric.
Anterior THAs get no spinal Narcotics. Standard approach THAs get 0.1-0.2 mg Duramorph.
 
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