Anaesthesia for Hip and Knee Surgery

A Case for Conscious (awake) regional Anaesthesia

Before your joint replacement surgery, A/Prof Kosh will discuss anaesthesia with you. The selection of anaesthesia is a major decision that could have a significant impact on your recovery. It deserves careful consideration and discussion with A/Prof Kosh and your anaesthetist.

Several factors must be considered when selecting anesthesia, including:

  • Your past experiences and preferences. Have you ever had anaesthesia before? Did you have a reaction to the anaesthesia? How do other members of your family react to anaesthesia?
  • Your current health and physical condition. Do you smoke? Are you overweight? Are you being treated for any condition other than your joint replacement?
  • Your reactions to medications. Do you have any allergies? Have you ever experienced bad side effects from a drug? What medications, nutritional supplements, vitamins, or herbal remedies are you currently taking?
  • The risks involved. Risks vary, depending on your health and selection of anesthesia, but may include breathing difficulties, allergic reactions and nerve injury. Your surgeon and anaesthetist will discuss specific risks with you.
  • Your healthcare team. The skills and preferences of your surgical and anaesthesia team play an important role in the selection of anaesthesia.

Types of Anaesthesia

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

Local Anaesthesia

Local anesthesia numbs only the specific area being treated. The area is numbed with an injection, that only lasts for a short period of time. Patients remain conscious during this type of anesthesia.  For major surgery, such as hip or knee replacement, local anesthesia may be used to complement the main type of anesthesia that is used. A.Prof Kosh uses High Volume Local Anaesthetic Infiltration in the peri-articular tissues. This injection consist of a local anaesthetic (Naropen) , anti- inflammatory (Ketorolac), Steriod (celestine), Adrenaline and Antibiotic (Vancomycin) . This injection has shown to be very beneficial in reducing narcotic (morphine) analgesia requirements. 

Literature review article on Local Anaesthetic Infiltration

Regional Anaesthesia

Regional anesthesia involves blocking the nerves to a specific area of the body, without affecting your brain or breathing. 

A/Prof Kosh advocates opioid and Benzo free anaesthetic. If you are suitable for day surgery arthroplasty we will keep you very comfortable throughout your conscious (awake) anaesthetic. You will be asked to bring along noise cancelling headphones/earbuds to either listen to music or watch a movie. 

The three types of regional anaesthesia used most frequently in joint replacement surgery are spinal blocks, epidural blocks and peripheral nerve blocks.

  • Spinal Block. In a spinal block, the anaesthesia drug is injected into the fluid surrounding the spinal cord in the lower part of your back. This produces a rapid numbing effect that wears off after several hours.
  • Epidural Block. An epidural block uses a catheter inserted in your lower back to deliver local anaesthetics over a variable period of time. The epidural block and the spinal block are administered in a very similar location; however, the epidural catheter is placed in a slightly different area around the spine as compared to a spinal block.
  • Peripheral Nerve Block. A peripheral nerve block places local anaesthetic directly around the major nerves in your thigh, such as the femoral nerve or the sciatic nerve. These blocks numb only the leg that is injected, and do not affect the other leg. One option for a peripheral block is to perform a one-time injection around the nerves in order to numb the leg just long enough for the surgery. Another option for this type of block is to keep a catheter in place, which can deliver continuous local anaesthesia around the nerves for up to several days after surgery.

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.

Literature Review supporting Regional Anasthesia over General Anaesthesia

Side effects from regional anaesthesia may include headaches, trouble urinating, allergic reactions, and rarely nerve injury.

General Anaesthesia

General anaesthesia is often used for major surgery, such as a joint replacement. General anaesthesia may be selected based on patient, surgeon, or anaesthtist preference, or if you are unable to receive regional or local anaesthesia. Unlike regional and local anaesthesia, general anaesthesia affects your entire body. It acts on the brain and nervous system and renders you temporarily unconscious.

  • Administration. With general anaesthesia, the anaesthetist administers medication through injection or inhalation. The anaesthetist will also place a breathing tube down your throat and administer oxygen to assist your breathing.
  • Risks. As with any anaesthesia, there are risks, which may be increased if you already have heart disease, chronic lung conditions, or other serious medical problems.

General anaesthesia 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.

 

A/Prof Kosh encourages his hip and knee replacement patients to have their procedure performed under regional anaesthesia. This minimises peri-operative complications. His anaesthetist Dr Sharma, Dr Kaliaperumal and Dr Wu are all very highly trained in regional anaesthesia techniques. They will be by your side through out the procedure and if at any time you fell anxious, panicked or distressed they will be there to make you comfortable and if required will give you a General Anaesthetic to sedate you or put you to sleep.  Attached is a link to a scientific paper showing lower 30day mortality for patients who underwent Regional Anaesthesia with superior outcome in hip and knee arthroplasty 

Anaesthesia Technique and Mortality after Total Hip or Knee Arthroplasty

 

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