Prior to your admission, you will be asked to complete a nursing interview. This will enable our anesthesiologists from Certified Anesthesia Services to provide appropriate services. The anesthesiologist will determine the type of anesthesia after consulting with you and your surgeon. Your anesthesiologist will administer the anesthesia and remain with you throughout the procedure until you are in the recovery room.
General and Regional Anesthesia for Orthopaedic Surgeries
Many types of anesthesia can be used for orthopaedic procedures. The type of anesthesia chosen depends on the nature and duration of the surgery, the patient’s health and medical conditions and the preferences of the patient, surgeon and anesthesiologist.
Very large or long operations usually require general anesthesia. This is frequently combined with regional anesthesia. Small, short procedures on the hand or foot can be done with local anesthesia alone or with a combination of local anesthesia provided by the surgeon and some sedation provided by the anesthesiologist (also known as MAC). Occasionally, neuraxial (epidural or spinal) anesthesia is chosen for hip or lower extremity surgery.
For knee replacement surgery, we are able to provide peripheral nerve blocks for relief of postoperative pain. Nerve blocks often substantially reduce the amount of pain a patient has in the first few days after surgery. Also, patients with nerve blocks usually require less anesthesia during the surgery itself, so they tend to wake up faster after surgery. If you or your surgeon are interested in a nerve block, please discuss it with your anesthesiologist to determine if you are an appropriate candidate for this type of anesthesia.
Types of Nerve Blocks
Supraclavicular block: The numbing medicine is injected above the collarbone, shallow to the lung and outside of the great vessels. This block is more widely used than in the past because newer technologies have made it safer. It provides anesthesia to the upper arm, elbow, wrist and hand.
Axillary block: The numbing medicine is injected under the armpit (the axilla). This generally provides good anesthesia for hand, wrist, forearm and elbow surgery.
Interscalene block: The numbing medication is injected toward the brachial plexus below the collarbone (clavicle). This type of regional anesthesia provides good anesthesia for wrist, forearm, upper arm and often shoulder surgery.
Infraclavicular block: The numbing medication is injected toward the brachial plexus below the collarbone (clavicle). This generally provides good anesthesia for wrist, forearm and elbow surgery.
Bier block: The numbing medicine is injected through an IV line in the arm being operated on, with a tourniquet around the upper part of the arm to hold the medicine in, preventing it from leaking out to the rest of the body. This type of block is useful for short procedures such as carpal tunnel surgery.
Rescue block: The numbing medicine is injected after surgery to make you more comfortable, or after one of the blocks above has been performed in order to complete your anesthesia.
Consultations before Surgery
If you have a complex medical condition or trouble with an anesthetic in the past, you may have a consultation with one of the anesthesiologists prior to your surgery date. Have your surgeon write you a prescription for a “pre-op consultation” with the Department of Anesthesiology. You may then call to make an appointment 202-537-4955 to discuss and plan your care as appropriate. The appointment MUST take place at least two days before your scheduled surgery or procedure. Anyone who wishes to schedule an appointment less than two days in advance of surgery will be directed to wait until the procedure date.
You may request a specific anesthesiologist by speaking with your surgeon or by calling the Anesthesia Office at 202-243-2280 several days prior to your surgery.