Mepivacaine Shows Promise for Pain Control after TKA

    An anesthetic agent largely abandoned decades ago could be making a comeback: Two studies from the Henry Ford Health System in Detroit have shown that mepivacaine is as effective for controlling pain after total knee arthroplasty as bupivacaine – the standard spinal anesthetic favored by anesthesiologists and orthopedic surgeons for years – with fewer side effects.

    In the studies, patients who received mepivacaine recovered normal function faster, which allowed for a quicker recovery and shorter hospital stays.

    Although the results appear promising, the researchers said more studies are needed to evaluate mepivacaine’s effectiveness on a larger scale for medium-length surgery. The findings add to a growing body of research involving similar shorter-acting medications with improved results.

    “Our studies suggest that mepivacaine has multiple advantages and few drawbacks compared to bupivacaine as a spinal anesthetic in knee replacement surgery,” said senior author Jason Davis, MD, a joint replacement surgeon at Henry Ford. “It shows promise as an ideal anesthetic by working long enough for most knee replacements without the excessive duration that can delay patients’ recovery.”

    Mepivacaine use became limited in the 1990s after research showed it had a higher incidence of post-surgery complications such as nerve irritation. More recent studies have refuted those previous concerns and have shown an improved side effect profile while allowing for faster return of nerve function.

    In the Henry Ford studies, researchers sought to evaluate the safety and effectiveness of mepivacaine compared with bupivacaine as a spinal anesthetic for pain control during total knee arthroplasty. One study involved a retrospective review of the clinical results of 156 knee replacement patients. The second was a smaller, randomized study of 32 patients that looked specifically at the timing of nerve recovery in the legs and urinary control.

    Dr. Davis noted that in both studies, patients who received mepivacaine had better urinary control, faster recovery of nerve function, and accelerated recovery compared with patients who received bupivacaine. Patients fared no worse with other side effects such as nerve complications, pain control, and nausea.

    “Advances in surgical technique and pain control have made for improved early outcomes in recent years,” Dr. Davis said. “Choosing the right anesthetic may now be the key to attain a faster recovery with a lower risk of complications after surgery.

    “Such shorter-acting medications have the potential to become the new standard for regional anesthesia during the migration to outpatient joint replacement.”


    Mahan MC, Jildeh TR, Tenbrunsel TN, Davis JJ. Mepivacaine spinal anesthesia facilitates rapid recovery in total knee arthroplasty compared to bupivacaine. J Arthroplasty. 2018 Jan 16. pii: S0883-5403(18)30017-2. doi: 10.1016/j.arth.2018.01.009. [Epub ahead of print]