Mepivacaine vs. bupivacaine in spinal anesthesia for total joint arthroplasty: a systematic review and meta-analysis

INTRODUCTION: Total hip and knee arthroplasties are among the most common surgeries worldwide. Advances in anesthesia and pain management have enabled fast-track pathways, with spinal anesthesia increasingly preferred over general anesthesia. Bupivacaine has been the traditional local anesthetic of choice; however, mepivacaine has gained attention due to its shorter recovery profile. We conducted a systematic review and meta-analysis comparing spinal mepivacaine versus bupivacaine in total joint arthroplasty. EVIDENCE ACQUISITION: We searched MEDLINE, Embase, Web of Science, and Cochrane databases for studies comparing spinal mepivacaine and bupivacaine in total joint arthroplasty. Statistical analyses were performed using R (version 4.2.2). Quality assessment and risk of bias were performed according to Cochrane recommendations. EVIDENCE SYNTHESIS: We included 13 studies comprising 4,167 adult patients, with 1,564 (37.5%) receiving spinal mepivacaine. Mepivacaine led to significantly faster motor function recovery (mean difference [MD] -30.70 min; 95% CI -44.71 to -16.70 min; P