Anaesthesia for Orthopaedic Surgery

Your anaesthetist will telephone you prior to your surgery to discuss your past medical and surgical histories, focusing on any issues or problems that you may have had. Your anaesthetist will also discuss which type of anaesthetic is the best option for you.

Several factors which are considered include:
  • your past experience with surgery and anaesthesia
  • your general health and physical condition
  • any reactions or allergies you have to medicines
  • the risks of each type of anaesthesia
  • the preferences of your surgical team.

Before your operation your anaesthetist will meet with you to confirm the type of anaesthetic and review any medical concerns. Often this is on the day of surgery.

Types of Anaesthetic

Regional Anaesthesia
Regional anaesthesia uses medicine injected around the spinal cord to numb the lower part of your body for surgery. You are also given medicine to make you sleepy and comfortable. The most frequent type of regional anaesthesia used in hip and knee joint replacement surgery is spinal anaesthesia.

Spinal anaesthesia requires the anaesthetic medicine to be carefully injected into your lower back around your spinal cord. The medicine numbs the spinal cord so that you have no feeling in your legs. Different medicines can be used to make the numbing effect last different lengths of time. We can also add long acting pain relief medicines (opiates) that keep you comfortable after the numbing effect of the spinal anaesthesia stops.
We often recommend spinal anaesthesia as the preferred method of anaesthesia for hip and knee joint replacements. This is because there are several advantages to using a spinal anaesthetic compared to a general anaesthetic for hip or knee replacement surgery. These include reduced blood loss, pain and confusion; and fewer complications from blood clots.
Stacks Image 2598
Sedation
Following administration of a spinal anaesthetic we routinely co-administer sedation. This means that you will be ‘asleep’ during the surgery so you should not be aware of any sounds or movement. Most people prefer this as it gives them peace of mind knowing that they will ‘sleep’ during surgery and ‘wake up’ after surgery in recovery.
Local Anaesthesia
Administration of local anaesthesia is very common for orthopaedic procedures. It is very effective at reducing pain and the amount of pain relief required following the operation. This is often injected under the skin around the wound when you are anaesthetised.

Hip and knee joint replacements receive local infiltration of anaesthesia into the various compartments around the incision and implants. This has been shown to be very effective at improving patients’ comfort, reducing the amount of pain medications required and improving early mobilisation. Often we leave a thin catheter securely in place so if it gets sore, additional local anaesthetic medications can be administered to ensure you are comfortable and able to mobilise. We aim to have you walking on the day of your hip or knee joint replacement surgery.
General Anaesthesia
This is the most common type of anaesthesia used for all orthopaedic procedures.

People often think of a general anaesthetic as being ‘put off to sleep’, however anaesthetists prefer to think of it as a state of carefully controlled unconsciousness. Initially a small cannula is placed into your vein and routine monitoring is attached. You will then be asked to breathe oxygen from a mask. Medicines administered via the cannula will gently ‘drift you off to sleep’. You are kept anaesthetised with a mixture of gases which you will breathe. This is done so that you will be unaware of the surgery and not feel pain. While you remain unaware of what is happening around you, your anaesthetist monitors you closely and constantly adjusts the level of anaesthesia.

Regardless of the technique chosen, your anaesthetist will stay with you during your operation to monitor you and manage both your medical needs and pain relief. Our intention is to ensure that you have the best possible outcome from your surgery.

After the Operation

Both your anaesthetist and the recovery room staff will continue to monitor your condition after surgery to ensure your recovery is as smooth and trouble-free as possible.

To help the recovery process you will be given oxygen to breathe, usually by a clear plastic facemask, and encouraged to take deep breaths and cough. You may feel drowsy, have a sore or dry throat, or feel a bit sick after you ‘wake up’. These effects are temporary and are usually short-lived. Only when you are fully awake and comfortable will you be transferred back to your room, ward or to a waiting area prior to returning home.

If you received a regional anaesthetic for your hip or knee joint replacement surgery, you should be pain free when you ‘wake up’. You will notice that your legs will feel numb and this usually resolves over the next hour or two. A ‘pain patch’ is often applied to your skin which slowly administers pain medication. This may be combined with a patient controlled anaesthesia device (PCA) which when pressed administers a set amount of pain relief. A small catheter may also be wrapped under the dressings around your wound. This is used to administer additional local anaesthetic to control your pain.
Stacks Image 2659

PCA device

 
Once back on the ward, you will be visited by your friendly physiotherapist who will help you stand and walk as you begin your recovery and rehabilitation.

Risks

Modern anaesthesia is generally a very safe process, however there are risks involved for all patients with the administration of any anaesthetic technique. Your anaesthetist will discuss the relevant risks with you prior to your surgery.
See the Related links on this page.
Practice Head Office
Orthopaedics WA
Suite 15, Wexford Medical Centre
St John of God Hospital Murdoch
3 Barry Marshall Parade
Murdoch WA 6150
Tel: (08) 9312 1135
Fax: (08) 9332 1187
Email Us

Office Hours: 9am–5pm
Monday to Friday (closed public holidays)
Our anaesthetists:
Professor Yates is usually uses Dr Alex Swann as his anaesthetist.
Assoc Prof Gareth Prosser usually uses Dr Clinton Paine as his anaesthetist.
Mr Gohil usually uses Dr Matt Harper as his anaesthetist.
Occasionally, we will arrange for you to see another specialist in order to optimise your medical condition before the surgery.
Stacks Image 2685

Dr Alex Swann

Stacks Image 2687

Dr Clinton Paine

Stacks Image 2718

Dr Matt Harper

Related links: