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Anesthesia for Hip Surgery
At some point before your joint replacement surgery, your doctor
will raise the issue of anesthesia. Many people will jokingly say,
"Just put me out, Doc, and wake me when it's over." But the
selection of anesthesia is a major decision that could have a
significant impact on your recovery. It deserves careful
consideration and discussion with your surgeon and your
anesthesiologist.
Several factors must be considered when selecting anesthesia,
including:
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Your past experiences and preferences. Have you ever had
anesthesia before? What kind? Did you have a reaction to the
anesthesia? What happened? How do other members of your family
react to anesthesia?
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Your current health and physical condition. Do you smoke?
Are you overweight? Do you drink or use recreational drugs? Are
you being treated for any condition other than your joint
replacement?
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Your reactions to medications. Do you have any allergies?
Have you ever experienced bad side effects from a drug? Which
drug? What were the side effects? What medications, nutritional
supplements, vitamins, or herbal remedies are you currently
taking?
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The risks involved. Risks vary, depending on your health and
selection of anesthesia, but may include breathing difficulties,
blood loss, and allergic reactions. Your surgeon and
anesthesiologist will discuss specific risks with you.
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The skill and preferences of your surgical team
Types of Anesthesia
There are three broad categories of anesthesia: general,
regional, and local.
Local Anesthesia
You are probably
familiar with local anesthesia. This is the kind of anesthesia
your dentist uses when repairing your teeth. Local anesthesia
numbs only the specific area being treated.
General Anesthesia
Most joint
replacement surgeries use either general or regional
anesthesia. General anesthesia affects your entire body. It
acts on the brain and nervous system, leaving you in a deep
sleep. Usually, it is given by injection or inhalation.
Administration
When general
anesthesia is used, the anesthesiologist will also place a
breathing tube down your throat and administer oxygen to
assist your breathing. General anesthesia is commonly used
if you are having an extensive surgical procedure that takes
a long time.
There are several types of general anesthetics. Your
anesthesiologist will discuss specific selections with you.
Risks
As with any
anesthesia, there are risks, which may be increased if you
already have heart disease or a chronic lung condition.
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General anesthesia slows both your heart and
breathing rates; therefore, doctors will constantly
monitor your heart, blood pressure, breathing, and body
temperature during the surgery.
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General anesthesia also causes your blood vessels to
open wider (dilate), which can result in a heavier loss
of blood during the surgery. You may want to consider
donating blood in advance of your surgery.
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The tube inserted down your throat may give you a
sore throat and hoarse voice for a few days.
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Headache, nausea, and drowsiness are also common.
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.
The two types of regional anesthesia used most frequently in
joint replacement surgery are spinal blocks and epidural blocks.
For surgery below the hip, a combination block that targets the
lumbar plexus and the sciatic nerve can numb only one leg.
Spinal
Block
In 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 hours,
depending on the drug used.
Epidural
Block
An epidural
block uses a small tube (catheter) inserted in your lower
back to deliver large quantities of local anesthetics over a
longer time period. The epidural block and the spinal block
are administered in a very similar location; however, the
epidural catheter is placed slightly closer to the skin and
farther from the spinal cord
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 clotting afterwards.
Side effects from regional anesthesia include headaches,
trouble urinating, and allergic reactions, which could be quite
serious.
The goals of postoperative pain management are to enable you to
do the required physical therapy and to minimize pain and stress. If
a general or spinal anesthesia was used during your surgery,
postoperative 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 was used during your surgery, the epidural
catheter can be left in place and anesthesia continued afterwards to
help control pain. You will also have control over the amount of
pain medication you receive, within preset limits.
You will be closely monitored to ensure that no complications,
such as excessive sedation or compartment syndrome (an excessive
build-up of pressure within the muscles), develop. Your doctor may
also prescribe other pain relievers, such as aspirin or ibuprofen,
to help control pain after surgery. However, if you are also taking
drugs to help prevent blood clots, your use of these pain relievers
or any other medications that could further thin the blood will need
to be monitored closely.
The proper use of pain relievers before, during, and after your
surgery is an extremely important aspect of your treatment. Proper
use of pain medication can encourage healing and make your joint
replacement a more satisfying experience. Take time to discuss the
options with your doctor, and be sure to ask questions about things
you don't understand.
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