Spinal Anesthesia Administered in Preoperative Holding for Total Joint Arthroplasty Is Safe and Improves Operating Room Efficiency

Neuraxial anesthesia (NA) has been shown to be safe and beneficial for patients undergoing total joint arthroplasty (TJA). It has not been determined whether it is safe to perform spinal anesthesia (SA) in a location other than the operating room (OR). This is a single-institution, single-surgeon analysis of 471 consecutive primary TJAs performed from November 2016 to March 2020. Rate of complications, length of stay, and disposition were compared. Eighty-nine percent of TJAs were performed under NA. Those receiving SA were less likely to require conversion to general anesthesia (GA) than those receiving epidural anesthesia (1.8% vs. 14.4%, p < 0.001). Conversion to GA cost 12 minutes of OR time. SA room time averaged 13.4 minutes shorter than GA room time (p < 0.001). The rate of complications was similar for all groups. NA administered in the preoperative holding area for TJA is safe and improves OR time. (Journal of Surgical Orthopaedic Advances 34(1):001-005, 2025)

Key words: total joint arthroplasty, neuraxial anesthesia, practice efficiency