Spinal Doses - THA & TKA

Important to balance of surgical duration and length of PACU stays. 
Recommended doses:
   • Primary TKA 1.5 -1.8 cc 0.5% Bupivacaine
   • Primary THA 2.6 -3 cc 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 cc 0.5% Bupivacaine

Revision THA (only actabulaum) 3 cc 0.5% Bupivacaine

 

For primary arthroplasties, selected patients are discharged the same day. In those cases, Mepivacaine 2% can be used. But we have a very limited supply of Mepivacaine - Please reserve Mepivacaine ONLY for same patients with a high likelihood of being discharged the on the day of surgery.