THR - Total Hip Replacement

Anaesthetics

There are three main anaesthetic choices for your hip replacement operation.

Spinal anaesthetic, with or without sedation

Epidural anaesthetic

General anaesthetic

Spinal anaesthetic

Local anaesthetic is injected into your lower back, near the nerves in your spine. You go numb from the waist downwards, you feel no pain during the operation, but you remain conscious, if you prefer, you can also have sedation to make you feel sleepy and relaxed.

Advantages of a spinal anaesthetic

You are less likely to have sickness and drowsiness after the operation and will probably eat and drink much sooner. You will be ready to get up and be mobile sooner, and do not need as much strong pain relief. During the operation you remain in full control of your own breathing and will breathe better after the operation. Less bleeding occurs during surgery, which reduces your risk of needing a blood transfusion.

Disadvantages of a spinal anaesthetic

Like all medical treatments, there are some side-effects and risks, but there are less for spinal and epidural anaesthetics than for general anaesthetic. You will be unable to move your legs, and you may feel itchy for a while

Sedation

Sedation is used in combination with a spinal anaesthetic to relax you or to make you sleepy during the operation. You can choose light or deep sedation, depending on your preference. To remain relaxed but awake, choose light sedation. In order to be asleep for the entire operation choose deep sedation. This is similar to a general anaesthetic in that you will not be aware of what happens during the operation, however not everyone is suitable for deep sedation.

Sedation can be tailored to your preference, but some who have sedation have memories of being awake in theatre.

You must discuss the level of sedation with your anaesthetist so that they know your preference.

Epidural

Epidural and spinal injections are very similar and often confused. In an epidural, the anaesthetist places a very fine plastic tube (epidural catheter) into your back which allows more local anaesthetic be given and topped up if necessary. Because of this, the effects of an epidural can last a lot longer than a spinal anaesthetic.

The anaesthetist may suggest an epidural if your operation is complex and expected to last longer than two hours, or if there is a need for longer-lasting pain relief after the operation.

Disadvantages of an epidural anaesthetic

General anaesthetic

During a general anaesthetic you are unaware of the operation and feel nothing. You will receive anaesthetic drugs (usually an injection into the cannula on your wrist). You will also need oxygen to breathe and sometimes, an injection of muscle relaxant.

You will have a breathing tube in your throat for the duration of the operation to make sure that you have sufficient oxygen and anaesthetic gas. If you need muscle relaxants, you will be unable to breathe for yourself and ventilator (breathing machine) will need to be used.

Advantages

You will be totally unconscious during the operation.

Disadvantages

A general anaesthetic does not provide any pain relief. You will need pain relief afterwards; some strong pain relief may be used, which can leave you feeling quite unwell. You may feel sick, if so alert your nurse as this can be treated with anti-sickness drugs. You may get a sore throat or damage to the lips or tongue as a result of requiring tubes to help you breathe. You may feel drowsy, have a headache, have blurred vision or shiver, again alert your nurse as these can all be treated or reduced. You may feel difficulty in breathing at first, but this should pass quickly.

Uncommon side effects are damage to teeth and gums, chest infection, and becoming conscious during the operation.

Risks of all anaesthetics

You may feel pain at injection points. You may not be able to pass water (urine), or may wet the bed. It may be necessary to put a catheter (soft plastic tube) into your bladder to drain urine for a day or so, but this is not a universal requirement.

Rarely patients may suffer a serious allergic reaction to the drugs being used, have a heart attack or stroke, die or have nerve damage.

An anaesthetic is also usually injected into the wound site around the acetabulum before the wound is closed up with stitches or clips. This gives a high level of local pain relief immediately after the operation.

If you are scared about anaesthesia, here is a link to a great article https://www.peerwell.co/blog/2018/10/22/scared-of-surgery-anesthesia

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Page last updated: 23 October 2018 - 21:15