Department of Anesthesia and Critical Care at HUP
Critical Care
Obstetrical Anesthesia
Thoracic Anesthesia
Joint Replacement Anesthesia
For Patients: What to Expect


Hospital of the University of Pennsylvania
Penn Presbyterian Medical Center

See also:
Penn Pain Medicine Center

Joint Replacement Anesthesia

Welcome to Penn Presbyterian Medical Center. We would like to congratulate you on your decision to trust Penn Orthopaedics with your joint replacement surgery.

Anesthesiologists and surgeons work hand-in-hand with the rest of the perioperative care team to ensure the best joint replacement experience possible.

While there are several anesthesia options available for joint replacement surgery, our ultimate decision is based on numerous factors. Those factors include medical condition, previous experience and discussions with your anesthesiologist and surgeon.

Many patients come in thinking, "Please just put me to sleep and wake me up when it is over." While this is an option, there are others to consider that might impact your recovery and total experience. Making an informed decision involves careful thought and discussion with your surgeon and anesthesiologist.

Planning the anesthesia for your total joint replacement involves planning for:

Anesthesia during surgery:
Anesthesiologists and surgeons at Penn Medicine recommend spinal anesthesia for your joint replacement surgery. Recent research suggests tat complications may be reduced after surgery with spinal anesthesia than with general anesthesia.

Pain management after surgery:
Our approach to controlling your pain after surgery follows a protocol based on the best available evidence and the experience of our team. It involves the use of regional anesthesia (nerve blocks) and the administration of oral and intravenous pain medications. We refer to our protocol as the MP3 (Multimodal Perioperative Pain Protocol).

General Anesthesia

General anesthesia keeps you in a deep sleep that affects your entire body. We will give you medicine through your vein that will put you to sleep.

Once you are asleep, the anesthesiologist will place a breathing tube down your windpipe. You will be breathing a mixture of oxygen, air and anesthetic gas that will ensure you stay asleep throughout the surgery.

Possible Side Effects:
Some of the common side effects for general anesthesia are nausea, vomiting, sore throat/hoarse voice, or the potential for dental damage. General anesthesia can have more serious side effects that are far less common. Your anesthesia team will monitor heart rate, blood pressure, breathing and body temperature throughout your surgery to ensure your safety.

Spinal Anesthesia

In spinal anesthesia, numbing medication is injected into the fluid surrounding the spinal cord in the lower back. This will numb your legs and block all sensation in the lower half of your body for several hours.

Most patients have two major questions about spinal anesthesia:

  1. "Am I going to be awake during my surgery?"
    The answer is NO. While spinal anesthesia provides surgical anesthesia during your surgery, you will be given sedatives that will help you relax and put you in a light sleep. The level of your sleepiness can be adjusted and you can be easily awakened, if needed. In other words, you will be sleepy but not completely out.
  2. "Should I worry about getting paralyzed after spinal anesthesia?"
    Spinal anesthesia is relatively safe and the chance of one of any major side effect happening is very rare. The needles used are very small and we make sure that you are not taking any blood thinning medication prior to performance of spinal anesthesia.

Possible Side Effects:
Side effects from spinal anesthesia may include short-term back pain, rare headaches, and trouble urinating. Nerve injury from needle trauma is very rare. Most of our patients don't remember the spinal being performed.

How is spinal anesthesia performed?
Once you are in the operating room, routine monitors for blood pressure, heart rate, and oxygen saturation will be applied before you are given medication. You will be placed in a sitting position leaning forward with a slightly hunched back. The skin in the lower back area will be cleaned and then a piece of plastic will be applied to cover your back, isolating the field. Your skin is numbed with local numbing medication; a longer needle will then be applied through the numb area. After the needle reaches the desired space, numbing medication is injected into the fluid surrounding the spinal cord. You will then lie down on your back to allow the medicine to settle in. We will make sure that you are comfortable, safe, and sleepy.

Advantages to using spinal anesthesia during hip or knee replacement surgery include:

  • You avoid general anesthesia and receive less medication, thus having fewer potential side effects.
  • After surgery, you are more awake with a lower chance of developing nausea and vomiting.
  • You experience less bleeding during surgery and fewer complications from blood clotting after surgery.
  • After surgery, spinal anesthesia usually lasts beyond surgical time. This makes your pain management after the surgery much smoother.

If you are not a candidate for spinal anesthesia, or your surgery is expected to be longer or involve more blood loss, general anesthesia will be the anesthetic of choice.

Pain Management after Surgery

At Penn Medicine, we believe early and aggressive pain control is necessary to increase your comfort and satisfaction and to improve the function of your new hip or knee. Multimodal pain control protocol provides the most benefits while minimizing the side effects of individual medications (such as nausea, vomiting, itching, bowl and/or bladder retention).

Your medication will include a combination of acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, naproxen, etc.), Gabapentin, and oral narcotics. In addition to the pain medications, we use regional anesthesia (nerve blocks) and injection of numbing medicine into the joint during surgery.

Your pain management plan will be tailored to fit your specific needs. Your anesthesiologist, orthopaedic surgeons, and rehabilitation specialists all work together to adjust your specific pain management plan.

For patients undergoing total knee replacement, Regional Anesthesia (peripheral nerve blocks) is routinely part of the pain management protocol. Your knee joint is controlled by two nerves: the femoral nerve (provides sensation for the front and sides of your knee), and the sciatic nerve (provides sensation for the back of your knee). For total knee replacement, femoral nerve blocks provide excellent pain control after surgery.

A femoral nerve block is usually performed in the holding area or in the operating room before we begin your anesthesia. The nerve location is usually identified by using small electric current that will twitch your thigh muscles. These twitches are not painful. The nerve can be also identified by using ultrasound technology. This will help us to "see" the nerves and blood vessels in the area that we are blocking. We will give you relaxing medication that will make you sleepy during placement of the nerve block. We usually leave a small catheter next to the femoral nerve until the day after your surgery.

Local anesthetics will be running continuously through the catheter immediately after the surgery until the next morning. The catheter will be removed after ensuring that you are comfortable with the prescribed medication either by mouth or via intravenous injection.

If you still have unanswered questions about anesthesia or pain management after surgery, email us your questions at:

Finally, we would like to affirm our commitment to you and assure you that at Penn Medicine you will receive exceptional care of the highest quality.

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