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Short-Acting Spinal Anesthetics for Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis
Ahmed Siddiqi1, Khalid M Yousuf2, David Conrad3
1Department of Orthopedic Surgery, Texas Center for Joint Replacement, Texas Health Resources, Dallas, Texas.
The Journal of Arthroplasty
|July 16, 2026
Summary
Short-acting spinal anesthetics improve recovery efficiency and reduce urinary retention after total hip (THA) and knee (TKA) arthroplasty compared to bupivacaine. Mepivacaine demonstrated the most favorable overall recovery profile in this analysis.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Evidence-Based Medicine
Background:
- Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly performed as outpatient or short-stay procedures.
- Early recovery milestones like ambulation and bladder function are critical for discharge readiness.
- The comparative recovery profiles of spinal anesthetic agents used in total joint arthroplasty (TJA) require further definition.
Purpose of the Study:
- To systematically compare the recovery profiles of commonly used spinal anesthetic agents in primary THA and TKA.
- To evaluate the impact of different intrathecal agents on length of stay, postoperative urinary retention, and other recovery outcomes.
Main Methods:
- A systematic review and network meta-analysis adhering to PRISMA 2020 guidelines were conducted.
- Searched major databases for randomized and comparative studies of spinal anesthetics in THA/TKA.
- Included 16 studies with 1,914 patients, analyzing bupivacaine, mepivacaine, chloroprocaine, lidocaine, and mixtures.
Main Results:
- Short-acting agents were associated with reduced lengths of stay in THA and TKA compared to bupivacaine.
- Mepivacaine and lidocaine showed significantly lower rates of postoperative urinary retention in both THA and TKA.
- Mepivacaine exhibited the most favorable overall recovery profile across outcomes, with no significant differences in nausea, vomiting, or readmissions.
Conclusions:
- Short-acting spinal anesthetics enhance recovery efficiency and decrease postoperative urinary retention following THA and TKA.
- Anesthetic duration is a key factor in optimizing early recovery within rapid-recovery protocols for total joint arthroplasty.
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