Abstract

The prevalence of total knee arthroplasty (TKA) and total hip arthroplasty (THA) continues to rise in the United States. Between 2012 and 2015, elective TKA and THA increased by nearly 50%, and there is a substantial increase in these procedures projected over the next decade. This increase reflects both an aging population and a higher number of younger patients electing for TKA or THA earlier in life. Advances in perioperative care and anesthesia have contributed to improved surgical outcomes, reduced complications, and shorter recovery times for this population. Spinal anesthesia offers advantages over general anesthesia, including decreased blood loss, shorter operative duration, reduced length of stay (LOS), and lower rates of readmission. Bupivacaine is currently the standard local anesthetic used for spinal anesthesia in TKA and THA because of its reliability and prolonged duration, which can potentially extend several hours beyond surgery. This extended duration may delay the return of motor and bladder function, hindering mobility and discharge readiness. However, an intermediate-acting local anesthetic, mepivacaine, provides a shorter duration that may facilitate earlier recovery and mobility and reduced urinary retention, but its use carries potential limitations, including risk of premature block regression, early postoperative pain, and historical concern for transient neurologic symptoms (TNS).

Author Details

Natalie Celia Whitten, DNP(c), BSN; David Sanford, DNP, CRNA, EMT-P

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Spinal Anesthesia, Mepivacaine, Bupivacaine, Replacement Arthroplasty, Total Joint Arthroplasty, Knee Replacement Arthroplasty, Hip Replacement Arthroplasty

Advisor

David Sanford

Second Advisor

David Fort

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-18

Full Text of Presentation

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Additional Files

Abstract.pdf (153 kB)

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