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Author Topic: General Anesthesia or Spinal Epidural for TKR  (Read 3228 times)

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Offline LoveFall

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General Anesthesia or Spinal Epidural for TKR
« on: September 29, 2011, 11:00:30 PM »
I am having my right knee replaced the end of this month and would like to have some opinions on the type of anesthesia used during surgery. In my orientation class at the joint replacement center one of the topics was anesthesia of choice for replacement surgery. The speaker said that spinal epidural was preferred over general anesthesia. They said the patient would not have as many side effects with the spinal epidural and that most patients pain was better managed with this type of anesthesia. Someone in our group asked what about hearing everything that was going on during the procedure, which they did not want to experience. The speaker said it was suggested to bring a iPod to listen to music and also another anesthesia would be used to put the patient in a twilight state if requested. I also talked with someone that had knee replacement surgery 7 months ago and she said her surgeon preferred she have the general anesthesia. This surgeons opinion was that the spinal epidural patients came out of surgery and their pain was not managed as well as with general anesthesia patients. Also another guy that had the spinal epidural said he heard the whole procedure and it was horrible. I want to make a good choice, but very confused. Please post your experience and opinion if you have info on either general anesthesia or spinal epidural differences. Thanks for the help. ???

Offline bevsk

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #1 on: September 30, 2011, 08:25:42 PM »
Hi
Although I had microfracture/stem cell op 4 weeks ago I was in a ward with people who had had knee replacement it was 50 50 for general vs epi. I would say just go with what you want. I had general and would do again every time. Good luck keep us posted
bevsk

Offline dm

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #2 on: October 03, 2011, 04:12:44 AM »
the choice on anesthesia is often a toss up between surgeon preference, patient preference, and things like how you tolerate anesthesia, etc. Bottom line... YouTube what a TKR procedure is, you can watch one that's been recorded, you'll see that there's sawing, hammering, etc that goes on. It ain't pretty. Yeah, they can give you a spinal and sedation so you are in that "awake but not with it" mode so you don't care what's going on, or you could just opt to be out completely and be woke up when it's over with.

Best advice - talk to your surgeon about what he'd recommend for you, and why, as he knows your situation, and your medical status.

Personally, having been through 6 knee arthroscopies in the last 10 years and having a TKR just around the corner, I'd rather just have them put me out and wake me when it's over - after having dosed me up with a hefty dose of fentanyl first.

they can do things like give you a femoral block for pain management while you're out - you'd not want to be awake for that anyway.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline LoveFall

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #3 on: October 03, 2011, 05:27:21 PM »
Thanks to everyone for their opinions. I will definitely talk with my surgeon. I tried as long as I could to put off this surgery, but since my left knee is also an issue I am out of time. The closer the TKR op gets the more nervous I am getting about the pain and unknown.

Offline starpolisher

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #4 on: October 03, 2011, 07:25:20 PM »
LoveFall,

I've had a double tkr, a spacer replaced in one knee (the original was too big) and scar tissue removed and an MUA on the other.  I also have had a revision done on both knees (I have heard it is a more difficult operation than an original tkr).  Each operation I had an epidural and was also sleeping.  I had no memory or knowledge of what was going on with the exception of the 2nd operation which required less.  I was talking to my surgeon and distracting him .... next thing I knew I woke up in recovery.  If you are going to have a tkr, I would think you would not want to feel the pain of the surgery!  I was numb from the waist down and couldn't feel a thing.  The first hospital was miserable; their pain mgt left much to be desired....both knees were done simultaneously and I was given morphine when the epidural wore off.  I changed hospitals after that first operation.....the pain was really horrible and the pain control was not good.  I went to an orthopedic hospital in NYC for my successive surgeries and pain mgt was wonderful there.  I had an epidural for several days plus a nerve block each time.  My pain control was FAR better.  I personally don't like a gneral anesthesia and have experienced both an apidural (when I had C-section) and general anesthesia and far prefer an epidural.  They can give you a shot to make you sleep with an epidural.  That is what I would suggest.  Once the epidural wears off, it is extremely painful!  I liked having the nerve block and epidural for the first few days. 

Offline LoveFall

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #5 on: October 04, 2011, 01:19:42 PM »
Thanks Starpolisher for your history and experience with epidural. I did have the opportunity to speak with a critical care nurse and her opinion was the epidural is a better choice then the general anesthesia per the side effects. She also said the patient is not in a sluggish/sleepy state for the next few days after surgery with the epidural, which makes the process of getting the patient up and moving quicker. Getting up and moving as soon as possible is the better route for the patient. Lastly, she told me not to worry about hearing anything during surgery per I will be given a medication that will keep me out until recovery. So - the more input I receive the better I feel about the epidural. Now I was told it is possible depending on my health that I may not have the epidural choice. Will not know this until receiving the phone call from the anesthesia group. I do have herinated disc in my lower back and have had epidural injections for the past 4 years to relieve the pain down my leg. So I am not nervous about the epidural procedure - just do not want to be awake. Sorry for the long post - getting close to surgery day and need to talk it out.

Offline starpolisher

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Re: General Anesthesia or Spinal Epidural for TKR
« Reply #6 on: October 04, 2011, 06:56:30 PM »
I totally understand how you feel.  The more information you have ahead of time, the better off you are.  Some hospitals have really good pain control and others are awful.  I have the complication of arthrofibrosis plus had both knees done at the same time the first go round.  I took the word of my orthopedic and a friend whose mother had a single tkr...same hospital and doctor.  I deeply regret having not explored hospitals as well as having a double tkr.  I do not recommend it.  I felt it was best to get it over with but I wound up with a very serious complication and unfortunatel it has changed my life for the worse.  Arthrofibrosis is very rare.....and no way of knowing if you are one of the unfortunates until afterwards.  Sadly NY, with all their sophisticated medical knowledge, honestly didn't know what to do post surgery for arthrofibrosis.  It wasn't until I moved to Indiana that I saw a big difference in how they approach this problem, rare as it is. 
I wish you the best of luck.















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