Spinal Anesthesia in Same-Day Discharge Total Hip Arthroplasty: Chloroprocaine versus Mepivacaine

Chloroprocaine spinal anesthetic may facilitate quicker postoperative recovery in total hip arthroplasty (THA) than mepivacaine due to its shorter duration of action and rapid metabolization, which could reduce time to ambulation and discharge. Given the increasing emphasis on same-day discharge (SDD) protocols in THA to improve efficiency and reduce healthcare costs, evaluating the impact of chloroprocaine on discharge timing and postoperative outcomes is critical. This study compared the clinical outcomes and safety of chloroprocaine compared to mepivacaine in SDD primary THA.

This retrospective study compared the spinal anesthesia used on 226 patients who underwent primary THA performed between November 2020 to June 2023. The surgical outcomes of chloroprocaine (n=97) versus mepivacaine (n=129) spinal anesthesia, including estimated blood loss (EBL), operative time, discharge time, and 90-day readmissions or emergency department visits, were assessed. Anesthesia-related complications such as hypotension, bradycardia, urinary retention, and post anesthesia care unit outcomes were also documented.

Baseline characteristics were similar between groups. The chloroprocaine group had significantly lower EBL, shorter operative times, and faster discharge times. No significant differences were observed between groups in anesthesia complications or postoperative nausea, vomiting, or headaches. Additionally, there were no differences in surgical complications.

For direct anterior approach primary THA, chloroprocaine spinal anesthesia was associated with reduced blood loss, shorter operative times, and faster SDD, with no cases of unplanned direct admissions. These results indicate that chloroprocaine spinal anesthesia can be utilized as a safe and effective alternative to mepivacaine in outpatient THA.