Hypobaric lidocaine reduced time to discharge for patients undergoing outpatient TJA
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DALLAS — For patients undergoing outpatient total hip or knee arthroplasty, hypobaric lidocaine significantly reduced time to discharge and physical therapy assessment compared with longer-acting spinal drugs or general anesthesia.
“In terms of anesthetic techniques, most of us don't pay a lot of attention to it, but in the last year or 2 years – because of the outpatient aspect – this has been has become critical,” Paul E. Beaulé, MD, FRCSC, said in his presentation at the Orthopaedic Research Society Annual Meeting. “Bupivacaine is slower [and] is longer-acting, and this is a mainstay of practice in orthopedics. And you have lidocaine, which is short-acting, but there's a bit of concern of transient pain or neurological symptoms,” he added.
Beaulé and colleagues performed a retrospective review of 241 cases of total joint arthroplasty (59% THA, 41% TKA) in which patients received either hypobaric lidocaine (n = 108), hyperbaric or isobaric bupivacaine (n = 112), or general anesthesia (n = 21).
Researchers found time from OR to discharge was 275.9 minutes in the lidocaine cohort, 416 minutes in the bupivacaine cohort and 391.9 minutes in the general anesthesia cohort. Similarly, time from OR to physical therapy assessment was 133.4 minutes in the lidocaine cohort, 292.8 minutes in the bupivacaine cohort and 268.2 minutes in the general anesthesia cohort.
No transient neurological symptoms or other complications were reported in any cohort. Beaulé noted the absence of transient neurological symptoms may be attributed to the use of hypobaric lidocaine rather than isobaric lidocaine, which involves more tissue penetration and is more commonly associated with transient neurological symptoms in literature.
“Surgical teams should consider employing hypobaric lidocaine during spinal anesthesia to further optimize same-day discharge total joint arthroplasty programs, as well as cost recovery,” Beaulé concluded.
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Beaulé PE, et al. Paper 163. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 10-14, 2023; Dallas (hybrid meeting).
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