Orthopedic Surgery

Northern California Anesthesia Associates performs anesthesia for thousands of orthopedic surgery cases at Washington Hospital every year. We care for an especially high volume of patients undergoing minimally invasive total knee and hip replacement surgeries. Our anesthesia team takes care of patients intraoperatively and follows patients through the postoperative period to help ensure high quality pain management immediately after the surgery. Options for anesthesia for total knee and hip replacement surgeries include epidural, spinal, general, or a combined technique.

What is an epidural? An epidural usually involves the placement of a very small, soft catheter into the space that is just outside the sac containing the spinal cord. The epidural catheter is usually inserted in the lower midline portion of the back while the patient is either in the sitting or side lying position. The epidural catheter is kept in place throughout the duration of surgery and until up to several days after the surgery depending on the patient’s recovery progress and type of surgery, allowing for the continuous administration of medication without further needle sticks. Side effects may include numbness and decreased strength in the legs, itching, and decreased blood pressure. Risks range anywhere from temporary back ache, bruise at the epidural insertion site, headache, and very rarely infection and nerve damage. Compared to other methods of pain management, the main benefit of the epidural is that the patient is able to get relatively superior pain relief while experiencing minimal systemic effects of medications such as drowsiness and decreased drive to breathe.

A spinal anesthetic is another technique sometimes employed for hip and knee replacement. In a spinal anesthetic, medication is given into what is called the subarachnoid space surrounding the spinal cord and is usually a single injection of medication without the insertion of a catheter. Because no catheter is inserted, after the surgery, pain medications would be administered primarily through an IV. Otherwise the risks and side effects of a spinal anesthetic are similar to that of an epidural.

A general anesthetic (patient is completely asleep) is also often used either in addition to the epidural/spinal anesthetic or alone. Usually a general anesthetic is used alone only in cases where the patient has a medical or anatomical condition where an epidural or spinal is not feasible or safe.