Before your joint replacement surgery, your doctor will discuss anesthesia with you. The selection of anesthesia is a major decision that could have a significant impact on your recovery. It deserves careful consideration and discussion with your surgeon and your anesthesiologist.
Several factors must be considered when selecting anesthesia, including:
There are three broad categories of anesthesia: local, regional and general.
Local anesthesia numbs only the specific area being treated. The area is numbed with an injection, spray or ointment that only lasts for a short period of time. Patients remain conscious during this type of anesthesia. This technique is reserved for minor procedures. For major surgery, such as hip or knee replacement, local anesthesia may be used to complement the main type of anesthesia that is used.
Regional anesthesia involves 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.
The three types of regional anesthesia used most frequently in joint replacement surgery are spinal blocks, epidural blocks and peripheral nerve blocks.
Advantages to regional anesthesia may include less blood loss, less nausea, less drowsiness, improved pain control after surgery, and reduced risk of serious medical complications, such as heart attack or stroke that — although rare — may occur with general anesthesia.
Side effects from regional anesthesia may include headaches, trouble urinating, allergic reactions, and rarely nerve injury.
General anesthesia is often used for major surgery, such as a joint replacement. General anesthesia may be selected based on patient, surgeon, or anesthesiologist preference, or if you are unable to receive regional or local anesthesia. Unlike regional and local anesthesia, general anesthesia affects your entire body. It acts on the brain and nervous system and renders you temporarily unconscious.
General anesthesia affects both your heart and breathing rates, and there is a small risk of a serious medical complication, such as heart attack or stroke.
The tube inserted down your throat may give you a sore throat and hoarse voice for a few days.
Headache, nausea, and drowsiness are also common.
The goals of postoperative pain management are to minimize discomfort and allow you to move with less pain in order to participate in physical therapy after surgery. Postoperative pain relief may be achieved using a combination of oral medications or intravenous medications.
A common method of pain control is called “patient-controlled anesthesia” or “PCA.” With PCA, you will be able to control the flow of intravenous medication, within preset limits, as you feel the need for additional relief.
If an epidural or peripheral nerve block was used for your surgery, the epidural or peripheral catheter can be left in place and anesthesia can be continued in the postoperative period to help control pain. You may also have control over the amount of pain medication you receive in these catheters, within preset limits.
You will be closely monitored to avoid complications, such as excessive sedation or falls.
The proper use of pain relievers before, during and after your surgery is an extremely important aspect of your treatment. Proper use of pain medication can encourage healing and make your joint replacement a more satisfying experience. Take time to discuss the options with your doctor, and be sure to ask questions about things you do not understand.