Lower Limb Arthroplasty

Total Hip Joint Replacement

Summary

• Dose: 3 ml isobaric 0.5% bupivacaine + 15 mcg fentanyl.

• Position: Sitting, immediately supine.

• Expectation: Surgical block for up to 3 hours post-spinal.

Evidence

• ED95 for total hip joint replacement has been reported as:

  • 12.3 mg (2.46 ml) isobaric 0.5% bupivacaine (patient lateral) for surgical duration 118 minutes [1].

References

1. Sell et al. Isobaric bupivacaine via spinal catheter for hip replacement surgery: ED 50 and ED 95 dose determination. Acta Anaesthesiol Scand 2006;50:217-221.

Total Knee Joint Replacement

Summary

Dose: 2.5 ml isobaric 0.5% bupivacaine + 15 mcg fentanyl.

Position: Sitting, immediately supine.

Expectation: Surgical block for up to 3 hours post-spinal.

Evidence

• ED95 for total knee joint replacement has been reported as:

  • 9.9-10.4 mg (1.98-2.08 ml) hyperbaric 0.5% bupivacaine (patient sitting, immediately supine) when surgical duration ~ 107 minutes [1].

  • 10.9 mg (2.18 ml) hyperbaric 0.5% bupivacaine (patient sitting, immediately supine) when surgical duration ~ 107 minutes [2].

  • 5 mg (1 ml) isobaric 0.5% bupivacaine (patient sitting, remain sitting for 2 min, then supine) when time from spinal injection to surgical finish is 116 minutes [3].

References

1. Kim et al. The effect of body mass index on spinal anaesthesia for total knee replacement arthroplasty, Anaesth Intensive Care 2012:40:410-416.

2. Kim et al. Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anaesthesia for total knee replacement surgery arthrroplasty. J Anesth 2013;27:72-79

3. Van Egmond et al. Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty. CJA 2018;65:1004-1011.