Joint Replacement Anesthesia and You
All anesthetics for total joint replacements at University of Maryland St. Joseph Medical Center (UM SJMC) are performed by board certified physician anesthesiologists. There are several types of anesthesia that can be performed for these surgical procedures and this decision deserves careful consideration and discussion between you, your anesthesiologist, and your surgeon. Factors that may influence this decision include:
- Health and physical condition
- Past experiences with surgery and anesthesia
- Medications and medication allergies/reactions
- Benefits and risks of each type of anesthesia
- Preferences of the surgery/anesthesia team and you
Before Orthopedic Surgery - Anesthesia
You will be referred by your surgeon to your medical doctor and/or specialists to obtain all of the necessary medical history and tests, perform a physical exam, and to make sure that you are in optimal health prior to your surgery. It is very important that you are clear on your current medications and doses prior to arriving on the day of surgery.
Special attention should be paid to blood thinners. If you are on blood thinners due to atrial fibrillation, stroke, heart stents, blood vessel disease and/or stents, or any other reason it is important to make sure that you coordinate a plan with your surgeon AND the prescribing physician in advance to ensure that dosage adjustments or discontinuing the drug is done in the proper way for your individual situation to minimize your risk of medical or surgical complications. The timing of stopping blood thinners can also influence the types of anesthesia that you will be eligible for.
You will also receive a call from a nurse at the hospital who will review your medical information and medications with you. It is very important to answer or call back when this phone call is received.
Types of Anesthesia for Orthopedic Surgery
This involves using numbing medication to eliminate sensation in your leg or legs for surgery. 90-95% OF TOTAL HIP AND TOTAL KNEE REPLACEMENTS PERFORMED AT UM SJMC ARE DONE UNDER REGIONAL ANESTHESIA. Some of the reasons that surgeons and anesthesiologists prefer this approach are decreased blood loss, fewer complications from blood clots, no sore throat, and less grogginess and nausea/vomiting after surgery. There are several types of regional anesthesia used at UM SJMC. The most common are:
- Spinal Block: The vast majority of regional anesthetics are done with this technique. After you are comfortably sedated there is numbing medication injected in your back. This will produce a numbing effect that will last for several hours. After you are positioned for the surgery you will be given medication through your intravenous line to make you sleepy for the surgery. It is a light sleep and you will breathe on your own but you will be very comfortable throughout.
- Epidural Block: Typically this technique is only used for bilateral knee replacements or anticipated lengthy surgery. It is very similar to a spinal block except there is a small tube (catheter) left in your back to deliver local anesthetics over several days.
You are put to sleep with medications through an intravenous line. This is a deep sleep that affects your entire body. After you are asleep, the anesthesiologist will place a breathing tube or device that will be used to deliver oxygen and anesthetic gas.
Your heart and breathing will be closely monitored at all times.
You will remain completely asleep and comfortable until the surgery is complete. As you awake, the breathing tube/device will be removed and you will be transferred to the recovery room.
ONLY 5-10% OF TOTAL HIP AND TOTAL KNEE REPLACEMENTS PERFORMED AT UM SJMC ARE DONE UNDER GENERAL ANESTHESIA.
Typically this choice is utilized because the patient has some medical reason that they cannot receive regional anesthesia. Such reasons may include a history of major spinal surgery, spinal conditions, recent blood thinner use, anticipated lengthy procedure, difficulty performing regional anesthesia, or patient preference.
While our anesthesiologists and surgeons generally prefer regional anesthesia for these procedures for reasons stated above it is important to know that general anesthesia is a very safe and effective alternative.