Spinal Doses - THA & TKA

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. ButPlease weconsider haveuse afor veryfor limitedhip/knee supplyreplacements 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 Mepivacaine - Please reserve Mepivacaine ONLY for patientssurgery with astaff. highRecovery likelihoodprofile in terms of beingmotor dischargedweakness theand onbladder thefunction dayis ofsuperior surgery.to
even low dose Bupivacaine. The PACU staff will be happy !