TOTAL KNEE REPLACEMENT ANESTHESIA
T
OTAL
K
NEE
R
EPLACEMENT
A
NESTHESIA
You will be seen by an anesthesiologist or pre ‐ operative nurse prior to your total knee replacement surgery.
Your medical history will be reviewed and a brief physical exam performed.
The anesthesiologist will discuss your anesthesia options including spinal anesthesia and general anesthesia.
Based on your history, physical exam, type of surgery, and other factors, your anesthesiologist may suggest one
particular anesthetic technique.
Following surgery, there are several options for pain management.
S PINAL A NESTHESIA
The most common anesthesia recommended for total knee replacements at Schneck is spinal anesthesia.
Spinal anesthesia removes all pain sensation and movement from your abdomen to your toes.
This is performed in the operating room, usually after intravenous (IV) sedation has been given.
You will be placed in the sitting position or lying on your side on the operating table.
A sterile solution will be used to clean your back and a sterile drape will be placed.
A numbing medication will be used to numb the skin, typically only a minor sting is felt.
Once you are numb, a small needle is used to inject an anesthetic solution into your back.
Once this medication is placed, you will positioned lying on your back.
The anesthesiologist will confirm that you have no sensation and that surgery can be performed safely, without pain.
You will also be sedated during your surgery so that you are comfortable and relatively unaware of your surroundings.
You may be numb for several
hours after the spinal is placed.
Your anesthesiologist can discuss the following risks and advantages in more detail if needed.
A
DVANTAGES
OF
S
PINAL
A
NESTHESIA
Easy to perform
Excellent operating conditions for the surgeon
Avoids use of an endotracheal (breathing) tube
Avoids side effects of general anesthesia including nausea, vomiting, sleepiness, and confusion
Decrease in blood clots
Less blood loss during surgery
Reduced need for intravenous (IV) pain medications
Decrease risk of surgical site infection
Decrease in pulmonary complications
D ISADVANTAGES OF S PINAL A NESTHESIA
Possibility that spinal anesthetic does not work.
If this is the case, general anesthesia will be used.
Headache
Other events such as spinal bleeding, backache, infection, seizure, high block (numbness above your abdomen), low blood pressure, nerve injury, or medication reaction.
G ENERAL A NESTHESIA
General anesthesia is a technique during which you will be unconscious, generally referred to as “being put to sleep”.
General anesthesia is started in the operating room.
You will be asked to breathe oxygen through a mask for several minutes.
A medication is given through your
IV that will put you to sleep.
Once asleep, a breathing tube or a device known as a laryngeal mask airway (LMA) will be placed.
You will stay asleep with an inhalational gas (a gas which you breathe), IV medications, or a combination.
Once the surgery is complete, the medication
will be discontinued and the LMA removed.
Your anesthesiologist can discuss the following risks and advantages in more detail if needed.
A DVANTAGES OF G ENERAL A NESTHESIA
Good option when spinal anesthesia cannot be performed such as:
Patients on certain types of blood thinners
Patients with low platelets
Patients with certain neurological conditions
Causes unconsciousness, you will not be aware of your surroundings during surgery
D ISADVANTAGES OF G ENERAL A NESTHESIA
Nausea/Vomiting
Sore throat (from the LMA placement)
Confusion, especially in elderly patients
Aspiration (contents from your stomach going into your lungs)
Dental
The
injury
Pulmonary need
for
Hypoventilation
(not embolism
breathing
(blood mechanical
well) clot ventilation
going to after
your lungs) surgery
Schneck Surgical Services
411 West Tipton Street │ Seymour │ 812-522-2349 │ www.schneckmed.org
O PTIONS FOR P OSTOPERATIVE P AIN C ONTROL
Your anesthesiologist will discuss options for pain control after surgery.
Typically, two nerve blocks are performed that provide numbing to the knee for several days following surgery.
The first is a femoral nerve block.
This block numbs the nerve that transmits pain signals from the front and sides of the thigh and knee.
The femoral nerve is relatively close to the skin in the groin area and runs down the leg.
Once the nerve is found, numbing medication will be placed surrounding the nerve and then a catheter, or long hollow tube through which medication can be injected, will be placed.
The catheter will stay in place for several
days following surgery and provide pain relief to your knee.
A separate block of the sciatic nerve is usually performed to numb the back of the thigh and lower leg.
The nerve blocks, both the femoral and sciatic, will be performed by the anesthesiologist in the exam room prior to surgery.
Sedating medications will be given to relax you before the blocks are done.
The femoral nerve block and catheter is usually performed first.
The anesthesiologist will clean your leg in the groin area with a sterile solution.
An ultrasound machine is often used to locate the nerve.
Once the nerve is visualized, numbing medication will be injected into the skin.
Some anesthesiologists use a nerve stimulator, in addition to the ultrasound, to help locate the nerve.
You may feel a tingling sensation or a muscle twitch when this is used.
Once the nerve is located, a strong numbing medication will be given that surrounds the femoral nerve.
Next, a catheter will be inserted which can be used to give numbing medication following surgery.
After surgery, an infusion pump will be started with a continuous infusion of numbing medication.
Numbness will last until the catheter is removed.
Next, the sciatic nerve block will be performed in a similar fashion to the femoral nerve block.
This block will be a one ‐ time injection of numbing medication that surrounds the sciatic nerve.
The site of the sciatic nerve block varies according to your anesthesiologist’s preference.
This block can be performed on the front, side, or back of your leg.
Numbness usually lasts around
12 hours.
You may begin to feel some pain on the back side of your knee once the numbness wears off.
This is normal and oral or
IV pain medications can help with the pain.
Following surgery, you will need to take special care until sensation returns as your leg may be weak in addition to the numbness.
You should not try to walk or get out of bed without assistance.
Nerve blocks are an excellent addition to your anesthetic.
They help reduce the amount of pain medication needed following surgery.
Pain medications can have unwanted side effects such as nausea, vomiting, itching, and sleepiness.
You will have both oral and IV pain medications available to you following surgery; they will not be denied if the nerve blocks are in place.
You will
also be sent home with several medications including: Acetaminophen, Gabapentin, Oxycodone, and Celecoxib.
Femoral Nerve Block Area of Numbness
Sciatic Nerve Block Area of Numbness
