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Anesthesia for Hip & Knee Replacement Surgery

Different types of anesthesia are possible for your surgery. Your anesthesiologist will further discuss these before surgery.

Several factors should be considered, including:

  • past experience with surgery
  • health and physical condition
  • reactions or allergies you have to medicines
  • risks of each type of anesthesia
  • preferences of your surgical team

Most hip and knee joint replacement surgeries are performed with general or regional anesthesia.

General Anesthesia

With general anesthesia, you are put completely to sleep and your breathing must be supported with a breathing tube. A machine will be used to breathe for you. Your heart and respiratory rate will be closely monitored during surgery.

Risks of general anesthesia include a sore throat and hoarseness from the breathing tube, as well as drowsiness, headache and nausea after surgery.

Regional Anesthesia

Regional anesthesia uses medicine to numb your leg or legs for surgery. You also are given medicine to make you sleepy and comfortable during surgery. The two types of regional anesthesia used most frequently in joint replacement surgery at Johns Hopkins Bayview are spinal blocks and selective nerve blocks.

In a spinal block, the anesthetic medicine is injected into your back. The medicine will numb the spinal cord so that you have no feeling in your legs. Different medicines can be used to make the numbing effect last different lengths of time. Nerve blocks are used by some anesthesiologists because of their ability to relieve pain after surgery and the fact that they are less affected by blood thinners.

A combination nerve block that targets the lumbar plexus (or femoral nerve) and the sciatic nerve numbs only one leg and is frequently used for knee and hip surgeries. Sometimes, a small catheter, which is connected to an infusion pain pump, may be left at the injecting site to allow for even longer pain relief after surgery.

There are several advantages to using a regional anesthesia during hip or knee replacement surgery. Studies have shown that there is less blood loss during the surgery and fewer complications from blood clots. Side effects from regional anesthesia include headaches, trouble urinating and allergic reactions.

Pain Relief After Surgery

The goals of pain management after surgery are to decrease pain and allow you to get out of bed to do physical therapy. After surgery, you will receive a device that provides pain medicine (usually morphine or dilaudid). This device has a button that you may press to get pain medicine. The amount of medicine may be changed if you are getting too much or too little. This device is called patient-controlled analgesia or PCA.

After you are able to drink fluids, you may be able to switch to oral pain medicines. Again, different types and dosages are available. Make sure you tell your nurse or doctor if you need more pain medication.

If a continuous nerve block was placed at the beginning of your surgery, the catheter can be left in place and local anesthetics continued to control pain. You will have control of an additional amount of local analgesia by pressing a button.

Pain control is very important after surgery so that you are comfortable and can get the best results. Make sure you understand the options that are available to help with pain control.

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