Important to balance surgical duration and length of PACU stays. Recommended doses of LA (with 10-15ug fentanyl): Primary TKA - 1.5-1.8 ml 0.5% Bupivacaine Primary THA - 2.6 -3 ml 0.5% Bupivacaine
Tips re: spinal dosing: -Start spinal once previous patient arrives in PACU - Look at vertebral height (vs height) - If unsure, check with surgeon re expected duration of surgery
Generally speaking, revisions are still amenable to spinal except in major THA revisions that involve both acetabular and femoral components, which are mostly done under GA.
Revision TKA - 2-3 ml 0.5% Bupivacaine
Revision THA (only actabulaum) - 3 ml 0.5% Bupivacaine
For primary arthroplasties, selected patients are discharged the same day. In those cases, Mepivacaine 2% can be used. Please consider use for for hip/knee replacements scheduled for same day discharge and other procedures/surgeries with expected duration less than 2h that is for same day discharge. Quick tips: Place spinal just prior to OR; discuss duration of surgery with staff. Recovery profile in terms of motor weakness and bladder function is superior to even low dose Bupivacaine. The PACU staff will be happy !
No Comments