During orthopedic surgery, anesthesia is one-way surgeons minimize pain or discomfort to the patient. There are three main types of pain-blocking anesthesia – general anesthesia, regional anesthesia, and local anesthesia.

General Anesthesia

With general anesthesia, the patient feels no pain.  The drug propofol is usually administered intravenously.  Propofol provides three things necessary for a pain-free surgical procedure:

• Analgesia – the patient feels no pain
• Anesthesia – the patient remains asleep
• Amnesia – the patient forgets the surgical experience

This type of general anesthesia works well for outpatient procedures as the dosage level can be regulated and is considered “light sedation” similar to getting a colonoscopy. Patients are NOT intubated with a breathing tube. The anesthesiologist just uses an oxygen mask or Laryngeal Mask Airway (LMA) device to ventilate the lungs. 

In orthopedics, general anesthesia is rarely necessary, thanks in large part to the development of robotic technology for joint replacement and resurfacing.  Minimally invasive surgical methods allow for smaller incisions, quicker procedures, and less anesthesia.  

Regional Anesthesia

Regional anesthesia allows for the patient to be awake as anesthesia is applied only to a particular region of the body to numb it.  This is often referred to as “block” anesthesia since they block the nerves, and therefore any sensation of pain, in a certain area.  Regional anesthetics are injected like lidocaine would be at the dentist – only to the particular area of concern. This type of anesthesia can be regulated to last for different lengths of time, depending upon the requirements of each individual procedure.

Oftentimes a spinal block is the form of regional anesthesia given for orthopedic surgery – particularly those cases dealing with the knee, hip, or ankle.  Spinal blocks – also called “spinals” are different from epidurals. Epidurals are often confused for “spinals”, but the word “epidural” actually refers to the location in which it is applied.   The word comes from it’s Greek roots Epi and Dura, meaning  “upon the dura mater”.  The medicine is injected into the epidural space around the spinal cord (particularly the “dura mater”). Epidurals are not used for orthopedic surgery but are common for childbirth.

Spinal blocks, however, are used to numb the lower extremity, from the waist down, so that the patient is pain-free and immobile during surgery. Spinal blocks involve the injection of numbing medicine directly into the spinal fluid.

Local Anesthesia

Local anesthesia is administered when a patient intends to remain awake for the duration of the surgery.  Local anesthesia doesn’t make you fall asleep. It instead works by preventing the nerves in the affected area from communicating sensations of pain to your brain.

Orthopedic surgeries usually do not use local anesthesia for surgical procedures, as that would only numb the skin, not the deep structures that affect nerves and tissues. Surgeons can administer a local injection upon completion of the surgery simply to provide local pain relief.  This cannot, however, be used as a pain management method during surgery since the patient would retain mobility during surgery. 

A Positive Patient Experience

General anesthesia, regional anesthesia, and local anesthesia are each valuable forms of pain management used in orthopedic surgery.  With a combination of spinal blocks and propofol, patients can experience safe and painless surgery.  Additionally, local anesthesia is given at surgical completion to relieve pain from the incision and procedure as the patient recovers. 

As a board-certified orthopedic surgeon, Dr. Tchejeyan continually strives for a positive patient experience.  He takes countless steps before surgery to prevent infection, and during & after surgery to prevent pain. 
To learn more about orthopedic anesthesia, contact our office to schedule a consultation with Dr. Gregory H. Tchejeyan.