Mepivicaine spinal for ortho

[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

 

[BLADEMDA]

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

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.

 

[BLADEMDA]

https://www.semanticscholar.org/paper/Time-of-return-of-neurologic-function-after-spinal-Mahan-Jildeh/c87fc33078751117f8e7a673c3e6f8baef182d02

Mepivacaine Versus Bupivacaine Spinal Anesthesia for Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis - PubMed

III.

pubmed.ncbi.nlm.nih.gov

 

[BLADEMDA]

 

[deleted1130227]

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

All the time, except for two surgeons who are outliers for surgical times.

 

[GassYous]

60 mg + a little fent

 

[CubsDynasty]

60 for every primary knee and a majority of primary hips, some slower surgeons are contraindicated.

 

[Arch Guillotti]

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

Your guys are too slow. 60 mg is plenty most of the time.

 

[sevo00]

45 mg for me

 

[BLADEMDA]

45 mg for me

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.

 

[sevo00]

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.

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?

 

[2Fast2Des]

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

 

[narcotics999]

2% 3cc for 1.[emoji2393]-2hrs. Surgeons are very aware of the timing.

 

[thinkorswim]

You guys must have slow surgeons. We use 36-40 mg for all primary joints.

 

[narcotics999]

You guys must have slow surgeons. We use [emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]]]]-[emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]] mg for all primary joints.

What’s wrong with slow surgeons? I get paid by hours.

 

[thinkorswim]

What’s wrong with slow surgeons? I get paid by hours.

I get paid by units, so I would rather do 4 total joints and be out at 3pm instead of 7pm.

Even in a time-based compensation model, there’s a point of diminishing returns. No one wants to be doing elective cases at night.

 

[Twiggidy]

Your guys are too slow. 60 mg is plenty most of the time.

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)

 

[GassYous]

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)

Skin to skin should be under 60 minutes

 

[deleted87051]

Skin to skin should be under 60 minutes

So 2 1/2 hours is slow? 😉

 

[Arch Guillotti]

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)

Primary total joint shouldn’t take longer than 45 minutes. Closing by a PA or whoever sometimes takes longer than thr joint replacement itself.

 

[thinkorswim]

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.

 

[Twiggidy]

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

 

[MirrorTodd]

Primary total joint shouldn’t take longer than 45 minutes. Closing by a PA or whoever sometimes takes longer than thr joint replacement itself.

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.

 

[ans2021]

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 😏