[Misc] Hip Replacement Anaesthetics

[Shropshire Seagull]

Yes, having a general carries a probability of risk [of death] - but so does driving a car ....

My last op was 2 years ago and I was offered both [due to being a type-1 diabetic] - went for general. Yes you feel a bit groggy for 24 hours but I'd always willingly sacrifice that for not be conscious while they hack me about.

As for "get it right first time" - feck me, are there seriously any hospitals that don't hold that objective ? "Nah, just stitch 'em up and we'll do it all again in 6 months time" really? C'mon!

 

[Weststander]

The odds of those scare stories from general anaesthetics are incredibly minuscule. For obvious legal reasons, hospitals have to mention them at the pre op. During the op, the team will carefully monitor your vitals and wellbeing, you’re in safe hands.

I found the recovery from general anaesthetics very quick, they only give just enough to keep you sedated and pain free throughout the op, so the half life effect is not into days (plural) afterwards.

 

[BLOCK F]

I have had both knees replaced under general anaesthetic and everything went well.
More recently, my wife had both kneecaps replaced; once under GA and the next time under spinal block and sedation. She much preferred the spinal and the anaesthetist was at her side throughout the op and said, any time you want more sedation just let me know.They had a good chat all through the procedure. All went well and she said she would always go for that option in future.
Very quick recovery time and no post anaesthetic sicky feeling that some suffer from.
Unless you are of a very nervous disposition, I would reckon spinal block is the way to go.
Good luck David and make sure you do the post op exercises........ very important.
P.S.Do I recall that your daughter is a doctor? Have a word!

 

[Harry Wilson's tackle]

I get to kill two birds with one stone here. Offer advice to David, who I troubled with my woes some time ago (possibly inappropriately...), & disagree with [MENTION=1200]Harry Wilson's tackle[/MENTION] for the first time in 700 odd posts.

There are inherent risks with any operation. Hip replacement, if carried out at a centre that follows the GIRFT (Get It Right First Time) criteria, is relatively low risk. Have a look at the National Joint Registry website http://www.njrcentre.org.uk and check outcomes for the surgeon and hospital taking care of you.

As soon as you add in a general anaesthetic (GA) you increase the risk significantly. Problems can occur on induction and throughout the anaesthetic including loss of secure airway, adverse reaction to medication, pneumothorax (collapsed lung), difficult/prolonged recovery. Some of these can kill you. The balanced argument should also state the potential problems with epidural/spinal anaesthetic. These include permanent nerve damage, bleeding, exposure to operating environment (some may find traumatic), prolonged recovery due to temporary paralysis. The key for me here is that none of these will kill you.

I have not listed every possible complication for either method as you'll hear this from your doctor/surgeon. You can discuss having a light sedation alongside the spinal/epidural, I would advise this. It will cognitively remove you from the situation and alleviate any anxiety about being present/in pain etc. A member of the operating theatre team is posted right beside you to ensure you are ok through your op, to provide emotional support, to explain what's going on if you're interested. This person will not leave you.

For what it's worth I've worked in various healthcare environments for twenty odd years as a clinician, and currently manage clinical services for an independent provider. We do more hip & knee replacements per year than any other independent in the uk, and more than the vast majority of NHS hospitals. I'm happy to PM or chat if you have questions.

Whatever you choose, the risks are minimal, but they are there. The potential implications of a GA are greater than those of a spinal. I know which one I'd choose. I wish you all the best and a speedy recovery.

Interesting comments. I am not claiming that general anaesthesia is risk free - I was offering my view on the risk benefit aspect. My perspective is informed by four things, one being my personal experience of general anaesthesia (had it maybe 10 times), another based on observation from my training (I learned how to use general anaesthesia in my research and was taught by the head of anaesthesiology at the university hospital where I trained), third by the awareness is that a hip replacement is not exactly a restful procedure, if I'm making myself clear, and finally (this may swing it in favour of spinal/epidural) my personal aversion to having things poked into my spine. In other words, my comments, though heartfelt, are personal and not informed by clinical judgement (I'm not a medic/clinician). The opinion of [MENTION=28232]jonnyrovers[/MENTION] carries more weight than mine because he is a proper doctor, not an opinionated scientist like me. Good luck

 

[jonnyrovers]

Yes, having a general carries a probability of risk [of death] - but so does driving a car ....

My last op was 2 years ago and I was offered both [due to being a type-1 diabetic] - went for general. Yes you feel a bit groggy for 24 hours but I'd always willingly sacrifice that for not be conscious while they hack me about.

As for "get it right first time" - feck me, are there seriously any hospitals that don't hold that objective ? "Nah, just stitch 'em up and we'll do it all again in 6 months time" really? C'mon!

Hip & knee replacement revision surgery is a huge cost to the NHS. Some hospitals and surgeons have better outcomes than others. GIRFT is a movement with the sole purpose of further narrowing an already narrow gap between good outcomes & great outcomes. It has nothing to do with shoddy workmanship.

 

[GT49er]

I am due to be having a Hip Replacement operation in a couple of weeks' time. Everyone assumes I must be in agony when I tell them that, which I'm not. I am well aware that something is wrong, but I am also on 3 different painkillers.

I am not worried about the operation itself, even though I have never been an in-patient before. But what I really don't know about is the anaesthetics. I had the pre-op assessment yesterday, which all went fine, but I really don't know whether to go for a general anaesthetic, or for the Spinal block option - an epidural to take care of the pain without being totally put to sleep, but being sedated to put you out.

I quite like the idea of not having to recover from a general anaesthetic, but don't fancy the idea (an understatement) of the possibility of "waking up" or being aware of what is going on.

Has anyone else had any experiences of such things?

I have had both hips replaced in the past 12 months, both with an epidural plus sedation. Remember nothing about either op. until I was tucked up in the ward. Vaguely remembered briefly hearing a sawing noise in the first one, but no pain. Having the epidural - the needle going in - was painful (for the second hip only, not the first time), but that only lasted a few seconds. Apart from the obvious pain 'running in' the new hip that was the only pain I experienced.

So, from personal experience, I would unreservedly recommend the epidural, with sedative. Good luck with the hip replacement(s).

 

[Harry Wilson's tackle]

Hip & knee replacement revision surgery is a huge cost to the NHS. Some hospitals and surgeons have better outcomes than others. GIRFT is a movement with the sole purpose of further narrowing an already narrow gap between good outcomes & great outcomes. It has nothing to do with shoddy workmanship.

Listen to this man - he knows what he's talking about. Most of the rest of us don't.

 

[maltaseagull]

I am due to be having a Hip Replacement operation in a couple of weeks' time. Everyone assumes I must be in agony when I tell them that, which I'm not. I am well aware that something is wrong, but I am also on 3 different painkillers.

I am not worried about the operation itself, even though I have never been an in-patient before. But what I really don't know about is the anaesthetics. I had the pre-op assessment yesterday, which all went fine, but I really don't know whether to go for a general anaesthetic, or for the Spinal block option - an epidural to take care of the pain without being totally put to sleep, but being sedated to put you out.

I quite like the idea of not having to recover from a general anaesthetic, but don't fancy the idea (an understatement) of the possibility of "waking up" or being aware of what is going on.

Has anyone else had any experiences of such things?

I had a hip replacement in 2016. Chose the spinal block option on the advice of the anaesthetist. I told him i didn't want to wake up and hear them sawing !
He promised I wouldn't ,as he would give me a light sedative, and I didn't.
I woke up just as they were about to wheel me out of the operating theatre and remember the surgeon saying "That went well Gordon"
The added bonus of the block was that it worked on pain relief all night.
Good luck with the op !

 

[jonnyrovers]

Interesting comments. I am not claiming that general anaesthesia is risk free - I was offering my view on the risk benefit aspect. My perspective is informed by four things, one being my personal experience of general anaesthesia (had it maybe 10 times), another based on observation from my training (I learned how to use general anaesthesia in my research and was taught by the head of anaesthesiology at the university hospital where I trained), third by the awareness is that a hip replacement is not exactly a restful procedure, if I'm making myself clear, and finally (this may swing it in favour of spinal/epidural) my personal aversion to having things poked into my spine. In other words, my comments, though heartfelt, are personal and not informed by clinical judgement (I'm not a medic/clinician). The opinion of [MENTION=28232]jonnyrovers[/MENTION] carries more weight than mine because he is a proper doctor, not an opinionated scientist like me. Good luck

Opinionated scientists will always ensure their opinions are well informed before sharing. Yours clearly are and as such are more than valid. Autoethnographic research is my favourite [emoji106]

I’m not a doctor.

 

[blue'n'white]

I had a hip resurfacing op 13 years ago - I was offered both the GA and an epidural and was told that you came round from the epidural a lot quicker but were awake all the time. The anaesthetist said "There is a certain amount of carpentry going on" so I had a general ! As they broke a couple of needles trying to get the epidural in anyway I thought it best ! Had the op on a Wednesday and was out Saturday morning. Had general twice recently too for injections in the other hip and woke up feeling right as rain after the procedure.
Good luck with your operation !

 

[Hastings gull]

I am due to be having a Hip Replacement operation in a couple of weeks' time. Everyone assumes I must be in agony when I tell them that, which I'm not. I am well aware that something is wrong, but I am also on 3 different painkillers.

I am not worried about the operation itself, even though I have never been an in-patient before. But what I really don't know about is the anaesthetics. I had the pre-op assessment yesterday, which all went fine, but I really don't know whether to go for a general anaesthetic, or for the Spinal block option - an epidural to take care of the pain without being totally put to sleep, but being sedated to put you out.

I quite like the idea of not having to recover from a general anaesthetic, but don't fancy the idea (an understatement) of the possibility of "waking up" or being aware of what is going on.

Has anyone else had any experiences of such things?

Have had both hips done - all the very best to you. Can I have your Albion ticket . .

 

[Reg]

I have had both mine done under general anaesthetic. I discussed it with a friend who is a very experienced anaesthetist and he suggested general, which I preferred as well.
I was very nauseous both times as the anaesthetic wore off, but for me, a small price to pay for oblivion during the process.
The first time, I stayed several nights, which I think is better. The second was only one night, which was a bit too short. If there is any leeway, I'd suggest opting for an extra night, but maybe not how things work these days.
It's a fantastic operation, I got back to playing five a side football and cricket and didn't miss a game (West Upper). The only time you remember them is at the airport.

 

[DavidinSouthampton]

Have had both hips done - all the very best to you. Can I have your Albion ticket . .

Thanks...…. and no, it's spoken for if I don't use it!

 

[DavidinSouthampton]

Thanks for all the comments thus far - both the serious informed ones and the jokey ones..... and the good wishes. All given me a lot to think about. I was told I don't need to decide until the day, so I will see if there is any specific advice on the day, such as "because of x, y and z, it would be better to do a, b and c".

The only health factor which might come in to it, I think, is a tendency towards high(ish) blood pressure - not a major problem, though.

 

[jonnyrovers]

Thanks for all the comments thus far - both the serious informed ones and the jokey ones..... and the good wishes. All given me a lot to think about. I was told I don't need to decide until the day, so I will see if there is any specific advice on the day, such as "because of x, y and z, it would be better to do a, b and c".

The only health factor which might come in to it, I think, is a tendency towards high(ish) blood pressure - not a major problem, though.

This will change your life. Big picture is far better than getting bogged down with detail. You’ll be fine in the long run.

 

[symyjym]

Great to see you back. Maybe behave yourself in the future ?

Hahaha. Didn't take long. Removed from a thread already by my mod stalker with a grudge.

If this forum cannot handle a fair discussion on the routes of terrorism, it should ban all stories on terrorism.

 

[El Presidente]

Thanks for all the comments thus far - both the serious informed ones and the jokey ones..... and the good wishes. All given me a lot to think about. I was told I don't need to decide until the day, so I will see if there is any specific advice on the day, such as "because of x, y and z, it would be better to do a, b and c".

The only health factor which might come in to it, I think, is a tendency towards high(ish) blood pressure - not a major problem, though.

I had general for a cartilage graft in October. The risks were explained beforehand with patience and professionalism, and being squeamish I opted for general. No problems coming out of it although I was on morphine for 36 hours and then Tramadol so was in a fairly cheerful mood at the time.

Best wishes for a speedy recovery.

 

[Drumstick]

As you seem aware both have pros and cons, personally I’d vouch for the spinal given generals can make people sick as a dog after and most patients I work with seem to do better with spinals.

If you’re nervous though then just go general, over before you know and take it very slowly with the food and water when you return!


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[Is it PotG?]

Spinal and sedation all day, back up on your feet in no time.

 

[DavidinSouthampton]

Spinal and sedation all day, back up on your feet in no time.

That's what I did. Operation was this morning - 26th - and has gone well.

I can quite understand the thoughts on both sides of this, and had decided to go spinal block if they could guarantee I would be unaware of what was going on. The vast majority are done that way these days apparently. There is the risk of permanent damage to the spinal chord, but the anaesthetist said the rusknus I in 10,000, and that is mire than he would do in his lifetime.

To cut a long story short, arrived at hospital at 7.30. Shown to room in a few minutes, talk with surgeon, anaesthetist, nurse, person to take bloods. Then changed and taken down to theatre. Sitting on couch talking to anaesthetist while he put the drip thing in the back of my hand. Next thing I knew I was waking up in recovery at 10.20 totally oblivious to everything that happened.

Thanks again for all good wishes etc. NSC is a wonderful place.