For patients having knee replacement surgeryknee replacement surgery, there are several options for anesthesia. The first is general anesthesia. This is the most common method of anesthesia used for patients having knee replacement surgery and involves “going to sleep” with a breathing tube inserted into the mouth. General anesthesia is not real sleep; it is more like an easily reversed drug-induced coma. The physician anesthesiologist will directly care for the patient or supervise the care by a nurse anesthetist or anesthesiology assistant who will monitor breathing and adjust the “depth” of anesthesia.
The second method is a spinal anesthetic, which can be accomplished with a single injection of numbing medicine into the spinal fluid. This option is easier on the lungs and also provides immediate pain relief after the surgery is over. For patients with heart or lung disease or sleep apnea, having spinal anesthesia may decrease the risk of complications after surgery including falls. The length of time that a spinal lasts is variable. Patients typically will still sleep during surgery with the assistance of intravenous medicines, but they will breathe on their own and without a breathing tube.
A related type of anesthesia is an epidural, which is similar to the technique used for pain control during labor. An epidural involves placing a tiny tube outside the spinal space to bathe the nerves in numbing medicine. This can be used for anesthesia during surgery and also for pain control afterwardspain control afterwards. There is a very small risk of bleeding around the spine following this procedure. Certain conditions like previous extensive spine surgery or taking blood thinners may preclude a patient from having these types of anesthesia.
Thirdly, general or spinal anesthesia can be combined with regional blocksregional blocks to the nerves in the leg. This includes temporarily numbing one or more nerves that supply the knee joint to help control pain after surgery. When combined with spinal anesthesia, the patient will still sleep during the procedure but will breathe on his/her own. The length of time before the nerve block wears off can vary. Like an epidural, a tiny tube can be placed next to the nerves to adjust the level of block and how long it lasts.
Benefits of regional anesthesia include less dependence on opioid pain medications, better sleep, and earlier rehab. With certain nerve blocks, muscle strength in the leg may be affected. After surgery, patients should ask for help when getting out of bed and only do things on their own when cleared by their physicians and physical therapists. There is a very small chance of bleeding around the nerves of the leg or damage to the nerve itself. Using ultrasound to see the nerves is a growing trend among anesthesiologists who offer nerve blocks.
Ultimately, the choice for type of anesthesia is decided by the patient with guidance from the surgeon and physician anesthesiologist.