Hyperbaric Bupivacaine Versus Hyperbaric Prilocaine in Spinal Anaesthesia

A Prospective, Double-blinded, Randomised Controlled Trial Comparing the Use of Hyperbaric Bupivacaine Versus Hyperbaric Prilocaine for Spinal Anaesthesia in Asian Patients Undergoing Elective Total Knee Replacement

Prilocaine numbs you for a shorter time, allowing you to regain movement quicker, which helps you recover faster, start rehab sooner, and feel more satisfied with your treatment overall.

Bupivacaine has long been the go-to choice for spinal anesthesia in total knee replacement surgeries due to its effectiveness in providing surgical anesthesia. However, it comes with some drawbacks, primarily its prolonged motor block and the potential for dose-related hypotension, which can hinder post-operative recovery. In contrast, prilocaine has gained popularity in recent years, particularly for outpatient procedures and even caesarean sections. Prilocaine's appeal lies in its faster recovery profile, characterized by a shorter duration of motor block and reduced incidence of urinary retention. These properties make it an attractive option for total knee replacement patients, as it potentially allows for quicker rehabilitation. The shorter-acting nature of prilocaine means patients may regain mobility sooner, potentially leading to earlier discharge and improved overall satisfaction. Despite these promising attributes, there's a notable gap in research comparing the intrathecal use of hyperbaric prilocaine 2% with hyperbaric bupivacaine 0.5%, especially within the Asian population. This lack of comparative studies highlights the need for further investigation to determine if prilocaine's benefits observed in other contexts translate effectively to total knee replacement procedures in Asian patients, potentially offering a pathway to enhanced recovery protocols in this specific demographic.

Inclusion Criteria:

• undergoing elective unilateral total knee replacement
• Able to give informed consent

Exclusion Criteria:

• Patients of age < 21 or > 90 years old
• American Society of Anaesthesiologists (ASA) physical status> III
• Extremes of weight: <40kg or BMI >40
• Contra-indications to spinal anaesthesia, prilocaine or bupivacaine (including allergy to local anaesthesia agents or patients at high risk for methaemoglobinemia)
• Complex TKR as deemed by surgeons
• Patient refusal
• Failure of spinal anaesthesia resulting in conversion to general anaesthesia, prior to start of operation
• Patients with prostate hyperplasia or urogenital pathologies
• Planning to conceive / pregnant women / breastfeeding