Orthopedic surgery can be done using a number of different anaesthetic options. However, not all options are available in all patients for all procedures. This is a very general overview of the common types of anaesthesia used for orthopedic surgery. Both your surgeon and your anaesthesiologist may have a specific preference for your procedure, so discuss your options with your doctors.
General Anesthesia is the most commonly used anaesthesia for most major orthopedic procedures. Prior to undergoing your procedure, the anaesthesiologist will give you medication that has you drift off to sleep. While sleeping, the anaesthesiologist will protect your breathing by using either a breathing tube in your trachea (windpipe) or a specialized oral airway in your mouth called a LMA.
General anaesthesia 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 anaesthesia,' where the patient can feel and hear, but is unable to respond under the anaesthesia. This complication is exceedingly rare, and can be prevented by special monitoring that has become routine for anaesthesiologists.
Epidural or Spinal Anaesthesia
Most people are familiar with epidural anaesthesia in the setting of childbirth. This type of anaesthesia is a good option for many lower extremity procedures, such as knee replacements. In the case of epidural anaesthesia, 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 anaesthesia may also be sedated during the procedure, but it is usually not necessary to place a breathing tube as is done during general anaesthesia.
Patients who undergo epidural or spinal anaesthesia may also be sedated during the procedure, but it is usually not necessary to place a breathing tube as is done during general anaesthesia.
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 Anaesthesia might be used for a few types of orthopedic surgery. Generally, local anaesthesia is only used for some types of hand and foot surgery, and some superficial procedures on the extremities. Using local anaesthesia is very safe, but it may not provide adequate pain relief in more invasive procedures.
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 anaesthesia, just in lighter doses. However, if a patient becomes too anaesthetized, the physician must be prepared to convert to general anaesthesia. Often IV sedation is used in combination with local or regional anaesthesia. The local/regional anaesthesia is used for pain relief, and the sedation is simply to calm the patient and make them less aware of their surroundings.
Further readings:
Mayo Clinic Foundation, Last Updated: June 16, 2006.
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