Joint Surgeons of Sacramento

Total Hip Replacement Overview: Anesthesia

Interactive Surgery

Introduction

Non-operative Treatment

Surgery Alternatives

Surgery Benefits

Risks and Complications

Cementless Surgery

Conclusions

Introduction

Before Surgery

In the Hospital

Going Home

Introduction

General Anesthesia

Spinal Anesthesia

Epidural Anesthesia

Combination Anesthesia

Multi-Modal Pain Management

Summary

Spinal Anesthesia

This type of anesthesia will completely numb the patient from the waist down. In a spinal anesthetic, a long, thin needle is passed between the vertebrae and enters the spinal canal. The skin and the tract that the needle follows are numbed by the anesthesiologist with a local anesthetic (Lidocaine). Once the spinal canal is entered, a small amount of spinal fluid is withdrawn to be sure that the needle is within the spinal canal. The anesthetic agent is then injected (either Lidocaine, Marcaine or Pontocaine). In addition, for post-operative pain control, a narcotic agent can be injected (Duramorph, Astromorph) and the needle is then withdrawn. The numbing medicine sets up quickly, within a few minutes, and the anesthesiologist checks to see the level of anesthesia which is usually up to approximately the waist level. Depending on the spinal anesthetic used, the numbing effect will usually last three to six hours. The narcotic agent, however, will provide pain control for approximately 12 to 18 hours.

Use of sedatives with amnesic properties given intravenously allows the patient to be unaware of the procedure and have no memory of the time during the surgery.

Spinal anesthesia has been shown to decrease the blood loss in hip surgeries and possibly decrease the chance of post-operative blood clot formation in the deep veins of the legs and pelvis.

A spinal anesthetic does carry a small risk of spinal headache. This occurs when there is a small leak of spinal fluid through the puncture of the dura. This is uncommon when very fine needles are used. If a spinal headache occurs, the treatment is usually bed rest with the head flat for approximately 24 hours. If the headaches persist, a "blood patch" can be performed by the anesthesiologist where a small amount of the patient’s own blood is injected in the epidural space and this helps to seal-off a dura leak.

The two common side effects from spinals are nausea and itching. Each of these occur approximately 20% of the time and can usually be controlled with other medications.