Best Anesthesia for Joint Replacement Surgery

Decrease Risk and Improve Comfort with Spinal Anesthesia

Doctor holding hip replacement
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Which anesthesia is best for your hip or knee replacement? Many people preparing to undergo joint replacement surgery are concerned about the potential risks associated with these major surgical procedures. One of the most common concerns is about the anesthesia used. The ideal anesthesia for a joint replacement will not only be safe, but will also be effective. This means that not only will there be few side-effects or complications associated with the anesthesia, but also that it will provide excellent pain relief and good results for recovery.

Hip and knee replacements are some of the most commonly performed surgical procedures. The number of these procedures is increasing every year, as more and more people turn to joint replacement for the treatment of severe arthritis. Also, more people are opting to have replacements, including both younger patients and older patients, further increasing the number of surgeries.

Anesthetic Options for Joint Replacement Surgery

The usual anesthetic decision is between a general anesthesia and a regional anesthesia. General anesthesia means the patient is completely sedated (sleeping), and usually, her breathing is aided with the use of a ventilator machine.

Regional anesthesia in joint replacement is usually accomplished with either a spinal or epidural anesthesia that numbs the lower extremities by placing a local anesthetic around the spinal nerves. During a regional anesthesia, sedation can be limited, allowing the patient to breathe without the aid of a machine.

Fewer Risks With Regional Anesthesia

A number of studies have looked into different risks of joint replacement, and how anesthetic choice influences the chances of potential complications developing. Some of the reasons doctors have come to recommend regional anesthesia in joint replacement surgery include:

  • Fewer medical complications (pulmonary problems, kidney failure)
  • Lower infection rate
  • Less blood loss

In addition, patients who had regional anesthesia have been found to have shorter hospital stays, and the cost of the joint replacement surgery has been less. All of these differences are small, but they do seem to be real.

How Regional Anesthesia is Performed

Regional anesthesia is accomplished by placing a local anesthetic around the spinal nerves to numb sensation to the legs. The anesthetic is administered through a small needle — similar to how women have an epidural anesthetic during childbirth. At that point, patients can choose to have more or less sedation during their surgical procedure, depending on their comfort.

If patients are particularly anxious, they may choose to have more sedation during their surgery. If patients choose to have less sedation, they may hear the surgical procedure, but they will not have pain. After surgery, the regional anesthesia tends to wear off slowly, allowing better pain control, and patients have less nausea and fewer side-effects when compared to general anesthesia.

Why is General Anesthesia Used?

If regional anesthesia has so many benefits, why would someone choose general anesthesia? Good question, but there are some good reasons to choose a general anesthesia. It may, for example, be good for someone who's had significant spinal surgery such as a lumbar fusion, which may make regional anesthesia more difficult. Spinal deformities, including scoliosis, may also make regional anesthesia more challenging. There are also general medical conditions, such as aortic stenosis, that make general anesthesia a safer anesthetic option. Every patient should discuss with the anesthesiologist the particular circumstances that may influence the decision for which anesthetic is best for their situation.

Another significant issue is that patients are often confused about what it means to have a regional anesthesia, or are anxious about having an injection given in the region of the spine. Education can significantly help so that patients understand that these anesthetics can be administered safely with a low chance of side-effects. Many patients who choose general anesthesia do so because they understand this option better than a regional anesthesia.

The Current State of Joint Replacement Anesthesia

It's currently difficult to know precise numbers, because the use of regional anesthesia has been dramatically increasing over the last several years. In the late 2000s, about 75% of joint replacements were performed under general anesthesia alone — about 10% under a combined general and regional anesthesia, and about 15% under regional anesthesia alone. As doctors and hospitals have become aware of the benefits of regional anesthesia for joint replacement patients, many hospitals have shifted to having more than 90% of joint replacement procedures performed under regional anesthesia.


"Regional anesthesia technique significantly improves outcomes of hip and knee replacement" Hospital for Special Surgery. May 1, 2013.

Mont MA, et al. "Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty" J Am Acad Orthop Surg December 2011 vol. 19 no. 12 768-776.

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