Not too many years ago, having joint replacement usually meant general anesthesia for surgery followed by grogginess and the need for strong narcotic pain-relievers afterwards. But now many surgeons are turning to newer regional and local anesthesia techniques when performing joint replacements, as research and experience are showing their benefits both during surgery and in recovery and rehabilitation afterwards.

Regional vs. General Anesthesia

Unlike general anesthesia, which knocks patients out so that they don’t experience pain during surgery, regional anesthesia allows patients to remain awake and blocks pain sensations for one area of the body. Joint replacement surgery is typically done with one of two types of regional anesthesia: a spinal block or an epidural block, says orthopaedic surgeon Michael Marks, MD, vice president of business development and former chief of staff at Norwalk Hospital in Norwalk, Conn. 

In a spinal block, the doctor injects an analgesic into the fluid surrounding the spinal cord in the lower back to produce an effect that can last for up to several hours. In an epidural block, the anesthetic is delivered to the epidural space – the outermost part of the spinal canal – through a catheter, which is left in place during surgery for the administration of pain medication.

Newer methods of anesthesia, often used along with spinal or epidural blocks – or in some cases with general anesthesia – include regional nerve blocks, which involve applying an anesthetic directly to the nerves (most commonly the femoral nerve for the knee and the brachial plexus for the shoulder) that supply the joint, and local infiltration, the administration of an anesthetic to the soft issues of the joint itself, Dr. Marks says.

Although nerve blocks have been available for some time, advances in ultrasound are making them more accessible – and precise, says Howard Konowitz, MD, a pain management specialist and anesthesiologist at Gottlieb Memorial Hospital in Maywood, Ill. “With ultrasound we are able to see under the skin and see the arteries, veins, nerves, muscle and tissue,“ he says.  “While we were doing it with other techniques prior to that, to actually visualize  and see the nerve and put the medication right there where you can see it gives you a much higher success rate.”