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Anesthesia Options

Information about different types of anesthesia used in orthopedic surgery

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Updated February 14, 2012

Orthopedic surgery can be done using a number of different anesthetic options, however, not all options are available in all patients for all procedures. This is a general overview of the common types of anesthesia used for orthopedic surgery. Both your surgeon and your anesthesiologist may have a specific preference for your upcoming procedure, so discuss your options with these doctors.
  • General Anesthesia
    General anesthesia is the most commonly used anesthesia for most major orthopedic procedures. Prior to undergoing your procedure, the anesthesiologist will give you medication that has you drift off to sleep. While sleeping, the anesthesiologist will protect you breathing by using either a breathing tube in your trachea (windpipe) or a specialized oral airway in your mouth called a LMA.

    General anesthesia is preferred by many people who prefer to be completely unaware of their surroundings. There has been concern in the media about a phenomenon called 'awake anesthesia,' where the patient can feel and hear, but is unable to respond under the anesthesia. This complication is exceedingly rare, and can be prevented by special monitoring that has become routine for anesthesiologists.

  • Epidural or Spinal Anesthesia
    Most people are familiar with epidural anesthesia in the setting of childbirth. This type of anesthesia is a good option for many lower extremity procedures, such as knee replacements. In the case of epidural anesthesia, a small catheter can remain in the back to provide pain relief both during the surgery and post-operatively.

    Patients who undergo epidural or spinal anesthesia may also be sedated during the procedure, but it is usually not necessary to place a breathing tube as is done during general anesthesia.

  • Regional Nerve Block
    Regional nerve blocks are becoming more an more popular in orthopedic surgery. These are done by placing numbing medication directly around the nerves that are affected by the surgery. Again, a small catheter can remain in place to provide post-operative pain control. In some cases, more than one nerve may need to be treated in order to achieve adequate pain relief during the procedure.

  • Local Anesthesia
    Local anesthesia is an option for a few types of orthopedic surgery. Generally, local anesthesia is only used for some types of hand and foot surgery, and some superficial procedures on the extremities. Using local anesthesia is very safe, but it may not provide adequate pain relief in more invasive procedures. Discuss with your surgeon if local anesthesia would be appropriate for your upcoming surgery.

  • Sedation, or MAC, Anesthesia
    Sedation is medication given through an IV to calm and relax the patients. Pain relieving medication can also be given this way. The patient must be monitored, as this is the same type of medication used in general anesthesia, just in lighter doses. However, if a patient becomes too anesthetized, the physician must be prepared to convert to general anesthesia. Often IV sedation is used in combination with local or regional anesthesia. The local/regional anesthesia is used for pain relief, and the sedation is simply to calm the patient and make them less aware of their surroundings.
As stated previously, this is a very general overview of some of the types of anesthesia used in orthopedic surgery. Your orthopedic surgeon and/or your anesthesiologist may have a specific preference for your upcoming surgery. I am not an anesthesiologist! This is simply an overview guide, and all of these types of anesthesia have their own risks that you must discuss with your anesthesiologist. He or she will be able to work with you to identify safe and appropriate anesthesia for your upcoming surgery.

Sources:

Anesthesia: A look at local, regional and general anesthesia Mayo Clinic Foundation, Last Updated: June 16, 2006.

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