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Joint Replacement Surgery Anesthesia Options

Updated 01/18/20 by Cory Calendine, MD, Orthopedic Surgeon

Prior to joint replacement surgery, you will meet with members of the surgical team to discuss anesthesia options and methods. The anesthesia techniques used can have a significant impact on your recovery and deserve careful discussion with your surgeon and/or anesthesiologist. There are several factors which can influence which anesthesia technique (or combination of modalities) is best for you, including:

  • Any past anesthesia experiences, preferences or reactions (or reactions in family members)
  • Pre-operative physical condition, general health and lifestyle (including smoking, obesity, other chronic health conditions)
  • Current medications or supplements and any history of medication reactions, allergies or intolerance
  • Personalized risk assessment of various anesthesia techniques
  • Preferences, skills, training of your surgical team.

Types of Anesthesia

General Anesthesia

General anesthesia acts centrally on the brain and nervous system to render you temporarily unconscious. General anesthesia is reserved for major surgery, including some joint replacement procedures. With general anesthesia, the anesthesiologist administers medication through injection or to the lungs via inhalation that affects the entire body. The unconscious state requires the anesthesiologist to place a breathing tube down the throat and administer oxygen to assist with breathing.

Again, general anesthesia affects your entire body, including your heart and breathing rates, leading to a small risk of a serious complications including heart attack and stroke. These risks may increase in patients with pre-existing heart disease, chronic lung conditions, or other systemic medical problems. Additionally, the tube inserted down the throat may cause a sore throat and hoarse voice for a few days post-operatively. Headache, nausea, and drowsiness are additional risks with general anesthesia but are less commonly seen.

General anesthesia has long been a safe option for hip and knee replacement surgery. Increasingly, many surgeons and anesthesiologists prefer regional anesthesia techniques (when possible) to reduce complication risk and improve the recovery experience with less pain, nausea and less narcotic medicine required.

Regional Anesthesia

Regional anesthesia is a general term used to refer to the injection of local anesthesia near nerves for temporary control of pain - blocking the nerves to a specific area of the body, without affecting your brain or breathing. Because you remain conscious, you will be given sedatives to relax you and put you in a light sleep. There are three basic types of regional anesthesia utilized most frequently in joint replacement surgery: spinal blocks, epidural blocks and peripheral nerve blocks.

Regional anesthesia injection at lumbar spine

Spinal Block

During a spinal block, the anesthetic drug is injected into the fluid surrounding the spinal cord in the lower part of the back. This produces a rapid numbing effect (predominantly below the level of the injection) that wears off after several hours.

A headache is the most common side effect of spinal anesthesia, and can typically be easily relieved.

Epidural Block 

An epidural block uses a catheter inserted into the lumbar area of the back  to deliver local anesthetics over a variable period of time. The epidural block and the spinal block are administered in a very similar body location (but placement of needle for spinal vs. catheter for epidural block is slightly different).

Epidural and spinal anesthesia are usually combined with other medicines that make you relaxed or sleepy (sedatives) or relieve pain (analgesics). These other medicines are often given via IV or may be injected into the epidural space along with the local anesthetic. You are monitored closely when receiving epidural or spinal anesthesia due to the medicine's potential affect on the central nervous, cardiovascular, and respiratory system. Both spinal and epidural anesthesia may affect blood pressure, breathing, heartbeat, and other vital functions, but the risk remains very low.

Epidural block injection diagram

Peripheral Nerve Block 

A peripheral nerve block places local anesthetic directly around the major peripheral nerve. A femoral nerve block involves an injection of local anesthesia into the groin region near the nerve supply of the thigh and knee. This type of block numbs only the leg that is injected, and does not affect the rest of the body. Options for a peripheral blocks include performing a one-time injection to numb the leg just during surgery or placing a catheter in place to deliver continuous local anesthesia around the nerves for up to several days after surgery.

Advantages to regional anesthesia can include decreased blood loss, less nausea and drowsiness, reduced risk of serious systemic medical complications (such as heart attack or stroke), and improved pain control after surgery. Like most medical procedures, regional nerve blocks are not completely risk free. Complications of nerve blocks may include infection, allergic reaction, nerve injury, or bleeding. Certain medical situations including increased bleeding risk, infection of the skin over the site, systemic infections, baseline neurologic deficits, and previous nerve injury may preclude some patients as candidates for regional nerve block anesthesia.  

Joint Replacement Anesthesia Summary

Because of the advances in anesthesia techniques and the risk factors, limitations and benefits of various modalities – it is important to discuss the pain control plan best for you. Each patient's circumstances, history and situation are unique. In general, most hip and knee replacement surgeries are completed utilizing one of the following combinations/options:

  1. Femoral nerve block catheter placement plus general anesthesia
  2. Epidural/spinal block technique plus sedation
  3. Femoral/nerve block and epidural/spinal technique with sedation
  4. General anesthesia

Let us know what questions you have about pain control for hip and knee replacement surgery. Multimodal anesthesia techniques are rapidly advancing - and offering patients more hope and options than ever.

RELATED VIDEO: How Painful is Joint Replacement Surgery?     Cory Calendine, MD, Orthopedic Surgeon

The Bone and Joint Institute of Tennessee works hard to optimize advanced anesthesia procedures to improve both pain management and post-operative function. Paul Thomas, MD, surgeon with our practice, explained in a recent Williamson Source article:

“We used to give general anesthesia to all joint replacement patients. Today that’s rare. We often use spinal anesthesia as opposed to general anesthesia, which is important because with general anesthesia, you’re more likely to be nauseated and have a change in your mental status when you wake up. Eliminating those issues with spinal anesthesia helps patients return home sooner.”

The average length of time our hip and knee replacement patients spend in the recovery room is 90 minutes. This is important since numerous studies have shown that the sooner you are able to get up and ambulate after joint replacement, the better your outcome. What additional questions do you have about anesthesia methods used for joint replacement surgery? Contact our office (CONTACT BUTTON above) or schedule an appointment today to come discuss your concerns. Follow us on Social Media and subscribe to blog below for continuing updates, news and alerts.

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Cory Calendine, MD is an Orthopaedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopaedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  

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