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Old 11-12-2007, 04:47 PM   #1
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Hip replacement & anesthesia

I would like to hear from someone on the pros and cons on spinal versus general anesthesia.
sv

 
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Old 11-13-2007, 03:59 AM   #2
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Re: Hip replacement & anesthesia

Choice of anesthesia method depends on such things as the patient's health status, risks involved, length of the surgery & preferences of the surgeon & the anesthesiologist. I have had two hip replacements using general anesthesia: the first was the preference of the anesthesiologist; the second was my choice.
Possible disadvantages of general might include a sore throat and/or hoarseness (from the tube that may be inserted to maintain an airway), drowsiness, and nausea post-op. I experienced no sore throat but I did have some nausea - it was brief in duration. In addition, elderly patients may experience confusion. Smokers and heavy drinkers may also be at higher risk of post-op complications. Post-op pain relief may be administered via their IV with a patient-controlled anesthesia machine (PCA) for a couple of days post-op; after the PCA is removed, the patient would begin oral pain meds.

There are two types of regional anesthesia: spinal block & epidural. Because regional anesthesia does not affect the brain, the patient will probably also be given sedative drugs to cause light sleep and no memory of the operation.

In a spinal block, anesthetic is injected INSIDE the dural sac into the subdural space.

A possible complication of spinal block is that the spinal fluid might seep through the opening in the dural sac caused by the injection needle; in turn, this may cause severe headache after the operation.

In an epidural, the anesthesiologist places a catheter (via the spinal anesthesia injection needle) OUTSIDE the dural sac in the epidural space.

With an epidural the dural sac is not punctured so there is no risk of escape of spinal fluid. In addition the epidural catheter may be left in place after the operation for hours and even longer and pain relieving drugs administered via the catheter.

The anesthesiologist may also inject a small dose of morphine directly into the subdural or epidural space after the operation for relief of postoperative pain.

Patients who receive spinal or epidural anesthesia are less likely to experience post-op drowsiness or confusion and "feel" better immediately after waking up from the sedation.

My own experiences with regional anesthesia with sedation have also been positive. I woke up immediately and felt well. The surgery wasn't joint replacement but the sedating drugs were the same ones that might be used with joint surgery.

 
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Old 11-13-2007, 02:19 PM   #3
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Smile Re: Hip replacement & anesthesia

Back when I originally had both hips replaced, I was given the option of epidural or general anesthetic. Both of those times, I opted for general (couldn't believe having my bones cut while I wasn't "dead to the world"). I needed to have the lining replaced in one of my hips 2 months ago & would have strongly considered epidural (as this revision was supposed to be a lot less invasive), however when I asked about having an epidural, was told no way.

But I did have something new to me - epidural morphine. It greatly reduced my post-op pain. I did have to put up with severe itching and puking (both relieved with further meds) - but the pain relief was remarkable.

If you're getting ready for a thr, good luck!

 
Old 11-17-2007, 09:59 AM   #4
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Re: Hip replacement & anesthesia

SV,
I had a THR in April of this year and had the spinal. The spinal was great, never knew what was going on because of the additional sedatives you get while having surgery and don't remember a thing. Post op pain was better EXCEPT...I had a history of very mild migraines before surgery, after surgery I had a killer headache which was not a spinal headache because lying flat did not help....I don't know if it was the spinal, but after surgery had killer migraines for about 5-6 months and any type of painkiller, even Alleve triggered them. MD called them rebound migraines (maybe triggered by the morphine PCA pump). Anyway 48 hours after surgery, we determined that I could take nothing for pain except for phenergan (anti-nausea drug). Would I do it again? Absolutely. 2nd best surgery I ever had.

 
Old 11-17-2007, 10:22 AM   #5
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Re: Hip replacement & anesthesia

I had a THR on 9/17. I was given a spinal and had no problems or complications. The thing I liked about having a spinal vs general was when you wake up the lower half of your body is still numb. Therefore you can get your wits about you before the operated area comes back to life and pain if any starts. In my case I was lucky the pain if any was very minimal.

 
Old 12-03-2007, 06:06 AM   #6
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Re: Hip replacement & anesthesia

Hi, I had a THR last Tuesday and elected to have the spinal. Although initially the sensation was a little weird once I had got used to absolutely no feeling below my ribs it was fine. I was slightly sedated but stayed awake throughout the procedure (my choice) - because I was sedated I felt very "remote" from what was going on (almost as if it wasn't my leg) and was even a little fascinated listening to the surgeon. Afterwards I needed very little morphine as my legs were numb for several hours, then none at all after 24 hours when I just had codeine, paracetamol and diclofenac. I was able to eat and drink almost straight away and apart from feeling very tired was OK.
If I ever have to have the other leg done I will definitely have a spinal again.

Good Luck.

 
Old 12-11-2007, 02:57 PM   #7
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Re: Hip replacement & anesthesia

there was no way in hell i wanted to stay awake for my op!!!! hehehe

but the docs said they wanted to give me an epidural as well as general so when i woke up i wouldnt be in pain with my hip, but for whatever reason, the epidural only worked on my good leg, not the one that got replaced, which can happen
after wards i was a little crokey but was feeling good and calling people to let them know how i got on, like a couple of hours after i woke up. i dont remember bein in much pain at all either. out of the 3 ops i have had, - hip replacement, surgery on my toe for arthritis and a bowel resection, that was the best one i have had, least amount of pain wise

 
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