Mepivicaine spinal for ortho

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ToKingdomCome

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How often are you doing these? What dose? I find when I do this it wears off towards the end of the case. And patient has decent amount of pain in pacu. Surgeon prefers it for early ambulation though
 
pubmed.ncbi.nlm.nih.gov

Mepivacaine Spinal Anesthesia Facilitates Rapid Recovery in Total Knee Arthroplasty Compared to Bupivacaine - PubMed

Mepivacaine for spinal anesthesia with TKA had adequate duration to complete the surgery and facilitated a more rapid recovery with less urinary complications and a shorter length of stay. Patients administered mepivacaine did not display worse pain control or transient neurologic symptoms...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I used it for outpatient total knee replacements. My dose was 45-60 mg and I found 60 mg to be more reliable to obtain satisfactory surgical duration of anesthesia.
 
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ToKingdomCome said:
How often are you doing these? What dose? I find when I do this it wears off towards the end of the case. And patient has decent amount of pain in pacu. Surgeon prefers it for early ambulation though
Click to expand...
All the time, except for two surgeons who are outliers for surgical times.
 
ToKingdomCome said:
How often are you doing these? What dose? I find when I do this it wears off towards the end of the case. And patient has decent amount of pain in pacu. Surgeon prefers it for early ambulation though
Click to expand...
Your guys are too slow. 60 mg is plenty most of the time.
 
BLADEMDA said:
I got burned a few times with 45 mg when the surgeon decided to eat lunch or see a patient or just take his time getting into the room. So, I switched to 60 mg and that solved any delay issue of 15 minutes.
Click to expand...


For us the surgeon is always in the room from the beginning. I do the spinal with surgeon in the room. Why would you start the spinal when you don’t even know where the surgeon is?
 
We have been doing 40mg (2cc) for the ASC knee replacements, noticing some improvement in urinary retention compared to heavy bupi. Gives about 2hrs, and I have had patients move themselves to the stretcher afterwards. If it starts to get a little more than 2 hrs just crank up the propofol and a little bit of fentanyl bolus to get them through
 
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thinkorswim said:
You guys must have slow surgeons. We use [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]]]-[emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]]][emoji[emoji[emoji6]][emoji[emoji6]]] mg for all primary joints.
Click to expand...

What’s wrong with slow surgeons? I get paid by hours.
 
Arch Guillotti said:
Your guys are too slow. 60 mg is plenty most of the time.
Click to expand...
Can you define slow? Because there's also a push for ambulatory knees at my place and even with the Bupivacaine spinals these same very surgeons are taking long enough that the patients still arrive in PACU moving. I've been worried that changing to low doses or to bupivacaine they're basically going to be moving during the case.

(Disclaimer, I think it also takes about a good 30 min for our OR to prep/drape our knees)
 
Twiggidy said:
Can you define slow? Because there's also a push for ambulatory knees at my place and even with the Bupivacaine spinals these same very surgeons are taking long enough that the patients still arrive in PACU moving. I've been worried that changing to low doses or to bupivacaine they're basically going to be moving during the case.

(Disclaimer, I think it also takes about a good 30 min for our OR to prep/drape our knees)
Click to expand...

Skin to skin should be under 60 minutes
 
Twiggidy said:
Can you define slow? Because there's also a push for ambulatory knees at my place and even with the Bupivacaine spinals these same very surgeons are taking long enough that the patients still arrive in PACU moving. I've been worried that changing to low doses or to bupivacaine they're basically going to be moving during the case.

(Disclaimer, I think it also takes about a good 30 min for our OR to prep/drape our knees)
Click to expand...
Primary total joint shouldn’t take longer than 45 minutes. Closing by a PA or whoever sometimes takes longer than thr joint replacement itself.
 
OR time should be 2 hours. That includes spinal, intubation, prep, etc. Blocks are done in a holding room. Surgical time is 45-60 min and a factory should have turnovers around 15-20 min.

Our surgeons will do 7-8 total joints in a day between two rooms with two teams. There’s almost no downtime for the anesthesiologist in either room and the last patient leaves PACU before 5pm.
 
Yeah. Of our total joint surgeons that I primarily work with that want to do Ambulatory thing only one of them is really coming close to that speed and even with that one it’s close. Just was curious
 
Arch Guillotti said:
Primary total joint shouldn’t take longer than 45 minutes. Closing by a PA or whoever sometimes takes longer than thr joint replacement itself.
Click to expand...
That right there is a major issue. I don't care how fast the surgeon can put the implants in, if s/he doesn't stay to actually finish the case, they're "surgical times" mean **** all. I'm glad I'm not the only one with this problem cause I was JUST about to post a thread asking if people have had issues with bupi wearing off too fast.
 
So are we saying 70-90 mins of tourniquet time for primary knee, and 3-4 hrs for a primary hip are slow? Just wanted to make sure 😏
 
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