Regional Anesthesia in Total Hip and Knee Arthroplasty
Regional Anesthesia in Total Hip and Knee Arthroplasty
The purpose of this study is to test whether the use of Ropivacaine and Mepivacaine are
 better in terms of effectiveness, cost, and safety than Bupivacaine as regional anesthetics
 in elective hip or knee replacement surgery.
Advances in pain management, regional anesthesia, and focused rehabilitation have increased
 the popularity of outpatient total hip and knee arthroplasty in a select group of eligible
 patients. However, one of the main impediments to same-day discharge is the prolonged motor
 block post-spinal anesthesia, as patients are routinely kept in the post-anesthesia care unit
 (PACU) until they demonstrate that the spinal anesthesia has worn off.

 At The Ottawa Hospital, the standard treatment for people receiving anesthesia during a total
 arthroplasty is the use of the anaesthetic, Bupivacaine. Mepivacaine and Ropivacaine are
 alternative anaesthetics that are also in use at The Ottawa Hospital. They are growing in
 popularity as anaesthetics because they and allow quicker recovery time when compared to
 Bupivacaine. Bupivacaine results in a long-lasting sensory-motor block, meaning that in the
 area that the local anesthesia was used, there is no sensation and limited movement for long
 periods of time. During hip or knee replacement surgery, you may want to have no sensation
 and the inability to move your lower limbs. However, it is not ideal for after surgery where
 weakness in the legs puts a person at increased risk for falls. Therefore, hospitalization
 after surgery typically lasts for a longer duration. Mepivacaine and Ropivacaine have a
 shorter motor block duration, allowing for a potentially earlier hospital discharge.
Inclusion Criteria:

 -  Patients undergoing total hip or knee replacement

 Exclusion Criteria:

 -  Study refusal

 -  Inability to provide consent

 -  Contra-indications to spinal anesthesia (refusal, infection, anti-coagulation,
 bleeding diathesis)

 -  Bilateral surgery

 -  Revision surgery

 -  Pre-exiting chronic pain or opioid consumption ≥ 30mg oxycodone or equivalent

 -  Pregnancy

 -  Not receiving preoperative adductor canal block for any reason

 -  Contra-indication to multimodal analgesia (acetaminophen or NSAIDs)

 -  Obstructive sleep apnea requiring extended PACU stay

 -  History of severe postoperative nausea and vomiting