Spinal Anesthesia Using Chloroprocaine is Safe, Effective, and Facilitates Earlier Discharge in Selected Fast-track Total Hip Arthroplasty

BACKGROUND: Spinal anesthetic choice plays an underappreciated role in total hip arthroplasty (THA). Chloroprocaine, a short-acting local anesthetic, has been limited to short-duration ambulatory procedures and has not been studied in THA. We compare perioperative outcomes of patients undergoing fast-track THA using chloroprocaine spinal anesthesia with those who have surgery with a longer-acting agent (bupivacaine). METHODS: A total of 143 THAs performed under spinal anesthesia by 3 arthroplasty surgeons between November 2018 and July 2019 were retrospectively reviewed. Patients receiving chloroprocaine were matched 1:1 by demographics to patients receiving bupivacaine. Ultimately, 74 patients were included (37 chloroprocaine and 37 bupivacaine). The primary outcome was hospital length of stay (LOS). Other perioperative outcomes were also evaluated. RESULTS: A total of 37 patients (50%) received chloroprocaine (60 mg), whereas 37 (50%) received bupivacaine (median 10 mg, range 8-15 mg). Among the matched groups, chloroprocaine use was associated with shorter hospital LOS (0.9 vs 1.2 days; P = .03), shorter operative time (68.2 vs 83.6 minutes, P = .03), lower estimated blood loss (184.7 vs 218.9 mL, P = .02), shorter postanesthesia care unit LOS (139.4 vs 194.9 minutes; P = .04), and less intraoperative hypotension (59.5% vs 83.8%, P = .02). Patients receiving chloroprocaine were also more commonly discharged home (100% vs 89.2%; P = .04). CONCLUSION: Chloroprocaine is a safe and reliable option for patients to mobilize rapidly and leave the hospital sooner after THA. Compared with bupivacaine, it is associated with shorter hospital LOS and higher likelihood for discharge to home.