Comparing Spinal Anesthesia With 1% Chloroprocaine Versus 1% Mepivacaine in Patients Undergoing Outpatient Primary Total Knee Arthroplasty

NCT07239999 | Not Yet Recruiting Phase 4 DMC

• 1 other identifier: DGH2025
• Study Type: interventional
• Target: 170
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study or clinical trial looking to compare 2 types of freezing medications injected into the spinal fluid at the lower back between the vertebrae in patients going to have total knee replacement surgery to check for early legs movement, early discharge from recovery room, walking and hospital discharge. This could save hospital cost of such procedures.

Conditions

Recovery Period; Anesthesia

Keywords

Spinal anesthesia; Outpatient total knee arthroplasty; Mepivacaine; Chloroprocaine

Outcome Measures

Primary Outcomes (2)

• Time to complete recovery of motor block

  Time from the intrathecal drug injection to the first documented instance of complete motor block recovery Bromage 0. Within approximately 2 hours for the Chloroprocaine group and 4 hours for the Mepivacaine group.

• Time to complete motor block recovery of lower limbs after spinal anesthesia

  Motor block will be assessed by PACU nurses in PACU using standard Bromage motor scale.

  From the time of intrathecal drug injection to PACU discharge. Within approximately 3 hours for the Chloroprocaine group and 5 hours for the Mepivacaine group.

Study Arms (2)

One arm receives spinal Mepivacaine 50 mg

ACTIVE COMPARATOR

One arm receives spinal Mepivacaine 50mg for total knee arthroplasty with adductor canal block

Drug: Mepivacaine Injection

Spinal Chloroprocaine group

ACTIVE COMPARATOR

Drug: Chloroprocaine Injection

Interventions

Mepivacaine Injection DRUG

Comparing time to motor block recovery in PACU, time to PACU discharge, time to ambulation and length of hospital stay

One arm receives spinal Mepivacaine 50 mg

Chloroprocaine Injection DRUG

Comparing time to motor block recovery in PACU, time to PACU discharge, time to ambulation and length of hospital stay

Spinal Chloroprocaine group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ASA I-III
• Elective outpatient TKA
• BMI less than 40
• Ability to provide surgical consent

You may not qualify if:

• Patient refusal
• Opioid tolerant
• Any contraindications to spinal anesthesia
• Chronic opioid use 3months or more

Sponsors & Collaborators

• Nova Scotia Health Authority: lead

Related Publications (23)

• Herndon CL, Martinez R, Sarpong NO, Geller JA, Shah RP, Cooper HJ. Spinal Anesthesia Using Chloroprocaine is Safe, Effective, and Facilitates Earlier Discharge in Selected Fast-track Total Hip Arthroplasty. Arthroplast Today. 2020 Jun 1;6(3):305-308. doi: 10.1016/j.artd.2020.04.007. eCollection 2020 Sep.

  PMID: 32509943 BACKGROUND

• Callaghan JJ, Mont MA. Editorial: Proceedings of the Knee Society: A Knee Society-Journal of Arthroplasty Collaborative Partnership! J Arthroplasty. 2022 Jun;37(6S):S1. doi: 10.1016/j.arth.2022.02.078. Epub 2022 Feb 26. No abstract available.

  PMID: 35227811 BACKGROUND

• Teunkens A, Vermeulen K, Van Gerven E, Fieuws S, Van de Velde M, Rex S. Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting: A Double-Blind Randomized Controlled Trial. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):576-83. doi: 10.1097/AAP.0000000000000420.

  PMID: 27281722 BACKGROUND

• Lacasse MA, Roy JD, Forget J, Vandenbroucke F, Seal RF, Beaulieu D, McCormack M, Massicotte L. Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial. Can J Anaesth. 2011 Apr;58(4):384-91. doi: 10.1007/s12630-010-9450-x. Epub 2011 Jan 4.

  PMID: 21203878 BACKGROUND

• Gilreath N, Liu J, Thomson C, Daher M, Caus S, Dunn H, Antoci V Jr, Barrett T, Cohen E. Retrospective comparison of chloroprocaine and mepivacaine in spinal anesthesia for same-day discharge TKA. Knee Surg Relat Res. 2025 Aug 7;37(1):33. doi: 10.1186/s43019-025-00283-4.

  PMID: 40775385 BACKGROUND

• Alhefeiti K, Patrascu AM, Lustig S, Aubrun F, Dziadzko M. Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty-Consecutive Case Series Study. J Clin Med. 2022 Sep 29;11(19):5771. doi: 10.3390/jcm11195771.

  PMID: 36233638 BACKGROUND

• Ghisi D, Boschetto G, Spinelli AM, Giannone S, Frugiuele J, Ciccarello M, Bonarelli S. Spinal anaesthesia with Chloroprocaine HCl 1% for elective lower limb procedures of short duration: a prospective, randomised, observer-blind study in adult patients. BMC Anesthesiol. 2021 Feb 20;21(1):58. doi: 10.1186/s12871-021-01279-9.

  PMID: 33610175 BACKGROUND

• Pillow CF, Brewbaker C, Wolf BJ, Barrett W, Hansen E, Brown A, Crawford D, Wilson SH. Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2025 May 1:rapm-2024-106342. doi: 10.1136/rapm-2024-106342. Online ahead of print.

  PMID: 40316299 BACKGROUND

• Schwenk ES, Kasper VP, Smoker JD, Mendelson AM, Austin MS, Brown SA, Hozack WJ, Cohen AJ, Li JJ, Wahal CS, Baratta JL, Torjman MC, Nemeth AC, Czerwinski EE. Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation. Anesthesiology. 2020 Oct 1;133(4):801-811. doi: 10.1097/ALN.0000000000003480.

  PMID: 32852904 BACKGROUND

• Forster JG. Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anaesthesiol. 2014 Dec;27(6):597-604. doi: 10.1097/ACO.0000000000000126.

  PMID: 25211156 BACKGROUND

• Siddiqi A, Mahmoud Y, Secic M, Tozzi JM, Emara A, Piuzzi NS, Culp B, Schwarzkopf R, Springer BD, Chen AF. Mepivacaine Versus Bupivacaine Spinal Anesthesia for Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2022 Jul;37(7):1396-1404.e5. doi: 10.1016/j.arth.2022.03.031. Epub 2022 Mar 17.

  PMID: 35306162 BACKGROUND

• Wyles CC, Pagnano MW, Trousdale RT, Sierra RJ, Taunton MJ, Perry KI, Larson DR, Amundson AW, Smith HM, Duncan CM, Abdel MP. More Predictable Return of Motor Function with Mepivacaine Versus Bupivacaine Spinal Anesthetic in Total Hip and Total Knee Arthroplasty: A Double-Blinded, Randomized Clinical Trial. J Bone Joint Surg Am. 2020 Sep 16;102(18):1609-1615. doi: 10.2106/JBJS.20.00231.

  PMID: 32960532 BACKGROUND

• Mahan MC, Jildeh TR, Tenbrunsel TN, Davis JJ. Mepivacaine Spinal Anesthesia Facilitates Rapid Recovery in Total Knee Arthroplasty Compared to Bupivacaine. J Arthroplasty. 2018 Jun;33(6):1699-1704. doi: 10.1016/j.arth.2018.01.009. Epub 2018 Jan 16.

  PMID: 29429882 BACKGROUND

• Camponovo C, Wulf H, Ghisi D, Fanelli A, Riva T, Cristina D, Vassiliou T, Leschka K, Fanelli G. Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial. Acta Anaesthesiol Scand. 2014 May;58(5):560-6. doi: 10.1111/aas.12291. Epub 2014 Mar 6.

  PMID: 24601887 BACKGROUND

• Casati A, Fanelli G, Danelli G, Berti M, Ghisi D, Brivio M, Putzu M, Barbagallo A. Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Anesth Analg. 2007 Apr;104(4):959-64. doi: 10.1213/01.ane.0000258766.73612.d8.

  PMID: 17377114 BACKGROUND

• Goldblum E, Atchabahian A. The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand. 2013 May;57(5):545-52. doi: 10.1111/aas.12071. Epub 2013 Jan 16.

  PMID: 23320599 BACKGROUND

• Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, Jouffroy L, Herman-Demars H, Bonnet F. Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study. Adv Ther. 2020 Jan;37(1):541-551. doi: 10.1007/s12325-019-01172-5. Epub 2019 Dec 11.

  PMID: 31828611 BACKGROUND

• Wesselink E, Hurk GJD, Vegt RV, Slagt C, Aa JV, Franssen E, Ven PV, Swart N, Boer C, Leeuw M. Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial. Reg Anesth Pain Med. 2019 Aug 21:rapm-2019-100673. doi: 10.1136/rapm-2019-100673. Online ahead of print.

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• Khurana BJK, Choudhary S, Singhal M, Rautela RS, Salhotra R, Singh A, Meena S. Comparison of Intrathecal Chloroprocaine With Bupivacaine in Short Gynecological Procedures: A Randomized Double-Blind Study. Cureus. 2023 Aug 27;15(8):e44187. doi: 10.7759/cureus.44187. eCollection 2023 Aug.

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MeSH Terms

Interventions

Mepivacaine; chloroprocaine

Intervention Hierarchy (Ancestors)

Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Study Officials

• HUSAM M NASHNOUSH, MBBCH, FRCPC

  Dalhousie University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

HUSAM M NASHNOUSH, MBBCH, FRCPC

CONTACT

001-902-410-9062; husam.nashnoush@nshealth.ca

Mohamed H Nashnoush, MED2

CONTACT

001-902-266-6010; mnashnoush@dal.ca

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: CARE PROVIDER
• Masking Details: Surgeons, PACU Nurses, OR Nurses, Physical therapists
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor Husam Nashnoush, MBBCH, FRCPC, Anesthesia Department, Central Zone, DGH, Halifax , NS

Study Record Dates

• First Submitted: November 14, 2025
• First Posted: November 20, 2025
• Study Start: March 31, 2026
• Primary Completion (Estimated): April 4, 2027
• Study Completion (Estimated): June 15, 2027
• Last Updated: February 6, 2026

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Jan2026 to Jan.2027
• Access Criteria: Anesthesia Department, Dalhousie University Research Office