The process used to decrease pain during and after your hip or knee procedure is a very complex one. The orthopedic team at the Plaza Joint Center utilizes some of the newest block techniques and medications to decrease pain both before and after surgery, improve rehabilitation, and allow for an early dismissal from the hospital. In consulting with your Plaza orthopedic surgeon and anesthesiologist, a number of factors must be taken into account, including:

• Your past experience with anesthesia,
• Your current health and physical condition,
• The medications you’re currently taking, including any nutritional supplements, pain medications, and/or herbal remedies,
• Your past history with anesthesia, pain medications, and your specific allergies to medicines,
• The risks associated with each specific anesthesia drug or technique.

The majority of patients at the Plaza Joint Center undergo regional anesthesia for their hip or knee replacement and therefore decrease the complications associated with general anesthesia.

Types of Anesthesia

There are three broad categories of anesthesia: general, regional, and local.

Local Anesthesia

This is the kind of anesthesia that is placed in the area of surgery to decrease sensation and pain. It is similar to the technique your dentist uses when repairing your teeth. It numbs only the specific area being treated. The surgeons at Plaza inject the soft tissues after joint surgery in combination with general or spinal anesthesia to decrease pain and expedite rehabilitation.

General Anesthesia

This method of anesthesia allows the patient to “go to sleep” and feel nothing during the surgery. The patient is placed on a breathing tube and vital signs are monitored very closely during the operation.

• Effects

  General anesthesia affects your entire body. It acts on the brain and central nervous system, placing you in a deep sleep. It is most commonly used if you are having a procedure that is expected to take a long time (more than 2-3 hours).

• Administration

  General anesthesia is usually given by injection or inhalation. There are several different drugs used for this purpose. Your anesthesiologist will discuss the specific options with you.

  When using this method of pain management, the anesthesiologist will also place a breathing tube in your throat and administer oxygen to assist your breathing.

• Risks

  General anesthesia entails certain known risks:

  • Both your breathing and your heart rate will become slower; therefore, these and other vital signs will be constantly and carefully monitored throughout your procedure.
  • Your blood vessels will tend to open wider, which may result in a heavier loss of blood during the surgery.
  • The breathing tube may cause you to have a sore throat or a hoarse voice for a several days afterward.
  • Headache, nausea, and drowsiness are also not uncommon.

Regional Anesthesia

Regional anesthesia involves numbing 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 during the surgery.

The two types of regional anesthesia used most frequently in hip and knee surgery are spinal blocks and epidural blocks.

• Spinal Block

  With a spinal block, the anesthesia is injected into the fluid surrounding the spinal cord in the lower part of your back. This produces a rapid numbing effect that can last for several hours, depending on the drug used. This technique is very commonly used at the Plaza Joint Center.

• Epidural Block

  An epidural block uses a small tube (catheter) inserted in your lower back to deliver quantities of local anesthetics over a longer time period. This method is rarely used for joint replacement at Plaza. Regional anesthesia for hip or knee surgery offers several advantages compared to general anesthesia. Studies have shown that there is less blood loss, fewer complications from blood clotting, and less nausea.

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Pain Relief After Surgery

One of the primary goals of post-operative pain management is to make you comfortable enough that you can perform and succeed in physical therapy.

If a general or spinal anesthesia is used during your surgery, post-operative pain relief may be delivered intravenously. You will be able to control the flow of medication, within preset limits, as you feel the need for additional relief. This process is often referred to as “patient-controlled anesthesia,” or PCA.

If an epidural block or a spinal was used, the anesthesia may continue to be administered through the catheter or by a long acting medicine (Depodur). Within preset limits, you will have some control over the amount of pain medication you receive.

Throughout the post-operative period, you will be closely monitored to ensure that no anesthesia-related complications develop. The anesthesia team may follow your pain control for up to two days.

Appropriate pain management before, during, and after your hip or knee surgery is a very important aspect of your treatment. Take time to discuss the numerous options with your Plaza orthopedic surgeon and one of the hospital’s expert anesthesiologists. Please feel free to ask questions about things you don’t understand.

Several of the doctors utilize a combination of methods to decrease pain and increase your ability to engage in therapy as soon as possible after your procedure.

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Frequently Asked Questions

“What are the main factors to be considered in the selection of anesthesia for hip or knee surgery?”

Your Plaza orthopedic surgeon and anesthesiologist will want to know whether you have ever had anesthesia before and, if so, what kind. They will also take into account your weight and overall health status, as well as whether you smoke, drink or use recreational drugs.

“What are the risks associated with anesthesia?”

The risks will vary depending on your overall health and the type of anesthesia selected. In general, however, they include breathing difficulties, nausea, blood loss, and allergic reactions.

“During rehabilitation, is it O.K. to seek additional pain relief from over-the-counter medications such as aspirin and ibuprofen?”

The use of “non-steroidal anti-inflammatory drugs” (NSAIDs) will need to be closely monitored by your medical team, as they may magnify the effects of whatever drugs you are taking to suppress the formation of blood clots. Your doctor will give you specific instructions on the best medicine to decrease pain and speed your recovery process.

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