Quicker recovery time. When a joint is painful after surgery, it’s natural to resist moving it to avoid more pain. But moving the joint is crucial to its functioning. By blocking pain in the first painful days after surgery regional nerve blocks and local anesthetics can help people move their joints and better tolerate physical therapy, says Dr. Konowitz. For knees, femoral nerve blocks can relieve pain, while allowing enough sensation to begin exercise soon after surgery.

Choosing the Right Anesthesia

While regional and local anesthesia techniques appear to have many benefits over general anesthesia, they are not without risks, including potential cardiac risks of getting too much analgesia, particularly if using epidural blocks, regional nerve blocks and local analgesics together, says Dr. Marks. 

Furthermore, spinal and epidural anesthesia are not appropriate for everyone, including those with spinal fusion, which would make placement of the needle difficult, or those with bleeding disorders for whom a puncture could cause dangerous bleeding around the spinal cord. In these cases, regional nerve blocks and local analgesia can still be useful for pain relief after surgery, says Dr. Marks.

Researchers are continuing to study the benefits or regional and local analgesia as well as ways to improve upon it. This includes improving the regional nerve blocks for hips, which have been less successful than those for the shoulder and knee, as well as finding the doses and placement of anesthetics to provide optimal pain relief while still enabling patients to move. 

“The pain fibers are small land the motor fibers are bigger, so theoretically you could [adjust anesthetic levels] to block the pain fibers and keep the motor fibers working,” says Dr. Hopkinson. “There is research on better ways to do that.”

For now, doctors recommend joint replacement patients speak with their surgeon before surgery to discuss pain-relief options, including whether their anesthesiologists use regional nerve blocks and/or local infiltration as well as their experience with those newer methods.

The goal, Dr. Konowitz, is not only to improve joint outcome, but to make the process of getting there easier. “When you look at how you can help someone have a better surgical experience, aside from giving you a good joint replacement, x-rays and pictures, it’s how you get that result.”