Date of Award

Spring 4-23-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Chai Sribanditmongkol, Ph.D., RN, IBCLC, CNS

First Committee Member

Dr. Joy Shoemaker, DNP, APRN, FNP-BC, CNE

Second Committee Member

Regina Prusinski, DNP, APRN, FNP-BC, CPNP-AC


lternative Options, Bupivacaine, Spinal Anesthesia, Total Knee Joint/Total Joint Arthroplasty/Total Hip Arthroplasty (TKJ/TJA/THA) Surgical Patients, Postoperative Urinary Retention (POUR), Delayed Ambulation, Increased Postoperative Urinary Retention

Subject Categories

Medicine and Health Sciences | Nursing Administration


Abstract Patients undergoing spinal anesthesia for total joint arthroplasty (TJA) must urinate and ambulate within 1-hour before discharge from the post-anesthesia care unit to indicate a healthy return of lower body neuro-function after spinal administration. The most common spinal medication used is bupivacaine which has complications including postoperative urinary retention (POUR), altered proprioception, delayed ambulation, and prolonged motor block, resulting in increased cost and length of stay. One alternative solution is mepivacaine, an intermediate local anesthetic lasting 1.5 to 2.5 hours with comparative surgical blockade but a quicker motor and sensory function return. Research suggests mepivacaine is just as safe and effective with fewer occurrences of POUR, delayed ambulation, increased LOS, and overall care costs than bupivacaine. Reports of increased PACU LOS due to POUR and delayed ambulation in TJA patients receiving spinal bupivacaine anesthesia occurred. So, this project aimed to ensure safe, quality, evidenced-based anesthesia care for patients undergoing TJA surgeries. The specific aim was to conduct a systematic record review of anesthesia provider questionnaire responses to evaluate the effects on provider knowledge and attitudes following a presentation of evidence-based practices involving intrathecal mepivacaine use in TJA surgical patients. A literature review was conducted, followed by a presentation to staff using evidence on spinal mepivacaine administration. Results from a retrospective analysis of pre-and post-presentation questionnaire responses indicate a commonly reported need among providers to improve anesthesia care for TJA patients. Findings demonstrate enhanced anesthesia providers' knowledge and attitudes, and stakeholders reported interest in implementing mepivacaine into their TJA program.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

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