Episode 42: Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial

In the era of fast-tracked surgery and same-day discharge, anesthesiologists are looking for strategies to optimize recovery without compromising safety or pain control. A long-standing debate centers around whether low-dose bupivacaine or mepivacaine is the better spinal agent to promote early ambulation after total knee arthroplasty. In this episode of RAPM Focus, RAPM Editor-in-Chief, Brian Sites, MD, explores this debate with Clinton Pillow, MD, following the May 2025 publication of “Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial.” This episode explores a topic faced by every anesthesiologist that manages joint replacements, especially total knee arthroplasty, has grappled with—what is the ideal spinal anesthetic when time is money and same-day discharge is the goal? Dr. Pillow is an assistant professor in the department of anesthesiology and perioperative medicine at the Medical University of South Carolina. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.