With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs).
Spinal anesthesia has become increasingly popular in the setting of hip and knee arthroplasty. Several reports suggest that spinal anesthesia is associated with a lower risk of complications when compared with general anesthesia.
Furthermore, with the increasing interest in fast recovery, including same-day ambulation and even outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used safely since the 1940s as a spinal anesthetic.
However, some reports have shown a higher risk of transient neurologic symptoms (TNSs) with the use of lidocaine, which has discouraged its use in the total joint population. Perioperative pain management and intraoperative anesthesia have become areas of increasing interest in joint replacement surgery. The rise in short-day arthroplasty, same-day ambulation, and even outpatient arthroplasties has only enhanced this interest.
Furthermore, the shift of health-care policy shifts from volume-centric to value-based reimbursement encourages decreased costs of care, improved clinical pathways, decreased length of stay, and a reduction in postoperative complications.
All anesthesia performed during this study was done so by the head of regional anesthesia at a major academic medical center. As such, the administration of anesthesia remained consistent. Furthermore, such consistency in dosing, technique, monitoring, and perioperative protocols may reduce the potential for developing adverse outcomes including TNS.
Also, all cases were performed in the hospital and not at an ambulatory surgery center. While we see no reason why the results of this study could not be extrapolated to an ambulatory surgery center outpatient model, it is important to differentiate the environment.
Also, surgeon technique remains essential, and high variation in surgical time may not make the use of short-acting anesthetics feasible. Isobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for same-day ambulation, short-stay TJA, and even outpatient hip and knee arthroplasty. In this small prospective cohort of consecutive patients, all patients were discharged on the day of surgery with rapid return of motor function and time to ambulation.
Risks Of TNS
There were no reports of TNS. Further study is necessary to differentiate the risks of TNS between arthroplasty procedures.