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This study will enroll patients 18-75 years of age who are undergoing elective primary total knee replacement. The patients will be randomized to receive one of two spinal blocks: 1) mepivacaine or 2) bupivacaine. The primary goal is to determine which group arrives at recovery of motor function first. Ultimately, this study will explore if mepivacaine leads to earlier return of motor function and ultimately earlier movement and discharge times following total knee replacement.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mepivacaine Spinal | Active Comparator | Mepivacaine (60 mg: 3ml of 2%) or will be injected into the intrathecal space. |
|
| Bupivacaine Spinal | Active Comparator | Isobaric bupivacaine (10mg: 2ml or 0.5%) will be injected into the intrathecal space. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mepivacaine Spinal | Other | spinal block using 60mg of mepivacaine |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Time until return of motor function following spinal placement | This will be defined as full strength with both 1) foot plantar and dorsiflexion and 2) hip flexion and 3) knee flexion in the non-operative extremity. | From anesthesia stop time until 7 days post-op |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulation | Time to first ambulation and distance at first ambulation | from anesthesia stop time until 7 days post-op |
| Length of Stay | based on anesthesia end time to time discharge order written |
| Measure | Description | Time Frame |
|---|---|---|
| Preoperative opioid use | Use of opioids in the pre-operative period converted to MME (morphine equivalent) | within past 90 days at time of procedure |
| Tourniquet use | Whether or not a tourniquet is used during surgery will be recorded as yes or no. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Clinton Pillow, MD | Medical University of South Carolina | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University of South Carolina | Charleston | South Carolina | 29425 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40316299 | Derived | Pillow CF, Brewbaker C, Wolf BJ, Barrett W, Hansen E, Brown A, Crawford D, Wilson SH. Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2025 May 1:rapm-2024-106342. doi: 10.1136/rapm-2024-106342. Online ahead of print. |
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Subject, surgeon, and care team members will be blinded to the assigned randomization group. The anesthesiologist will not be blinded.
| Bupivacaine Spinal |
| Other |
spinal block using 10mg of bupivacaine |
|
| Time from anesthesia end time to when discharge order is written, up to 30 days post-op |
| Side Effects | Side effects such as Urinary retention, dizziness, symptomatic hypotension, transient neurologic symptoms | 0-48 hours post spinal placement |
| Pain Scores | Visual Analog Pain Score 0-100 pain scores at rest, and with movement. A lower pain score means a better outcome. | Pacu to 48 hours post-spinal placement |
| during procedure for up to 7 days hours after procedure ends |
| Cement use | Whether or not a cement is used during surgery will be recorded as yes or no. | during procedure or up to 7 days hours after procedure ends |
| Robotic or not | Whether or not the procedure is robotic or not will be recorded as yes or no. | during procedure or up to 7 days hours after procedure ends |