Too much stress can increase pain and make it more difficult for people with chronic pain conditions, such as arthritis, to cope with the added burdens imposed by their disease. Immune function, stress and disease are interconnected. Stress and pain develop into a cycle: stress – pain – more stress – more pain.
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Orthopedic surgery can be done using a number of different anesthetic options, however, not all options are available in all patients for all procedures. This is a general overview of the common types of anesthesia used for orthopedic surgery. Both your surgeon and your anesthesiologist may have a specific preference for your upcoming procedure, so discuss your options with these doctors.
General Anesthesia
General anesthesia is the most commonly used anesthesia for most major orthopedic procedures. Prior to undergoing your procedure, the anesthesiologist will give you medication that has you drift off to sleep. While sleeping, the anesthesiologist will protect you breathing by using either a breathing tube in your trachea (windpipe) or a specialized oral airway in your mouth called a LMA.
General anesthesia is preferred by many people who prefer to be completely unaware of their surroundings. There has been concern in the media about a phenomenon called ‘awake anesthesia,’ where the patient can feel and hear, but is unable to respond under the anesthesia. This complication is exceedingly rare, and can be prevented by special monitoring that has become routine for anesthesiologists.
Epidural or Spinal Anesthesia
Most people are familiar with epidural anesthesia in the setting of childbirth. This type of anesthesia is a good option for many lower extremity procedures, such as knee replacements. In the case of epidural anesthesia, a small catheter can remain in the back to provide pain relief both during the surgery and post-operatively.
Patients who undergo epidural or spinal anesthesia may also be sedated during the procedure, but it is usually not necessary to place a breathing tube as is done during general anesthesia.
Regional Nerve Block
Regional nerve blocks are becoming more an more popular in orthopedic surgery. These are done by placing numbing medication directly around the nerves that are affected by the surgery. Again, a small catheter can remain in place to provide post-operative pain control. In some cases, more than one nerve may need to be treated in order to achieve adequate pain relief during the procedure.
Local Anesthesia
Local anesthesia is an option for a few types of orthopedic surgery. Generally, local anesthesia is only used for some types of hand and foot surgery, and some superficial procedures on the extremities. Using local anesthesia is very safe, but it may not provide adequate pain relief in more invasive procedures. Discuss with your surgeon if local anesthesia would be appropriate for your upcoming surgery.
Sedation, or MAC, Anesthesia
Sedation is medication given through an IV to calm and relax the patients. Pain relieving medication can also be given this way. The patient must be monitored, as this is the same type of medication used in general anesthesia, just in lighter doses. However, if a patient becomes too anesthetized, the physician must be prepared to convert to general anesthesia. Often IV sedation is used in combination with local or regional anesthesia. The local/regional anesthesia is used for pain relief, and the sedation is simply to calm the patient and make them less aware of their surroundings. As stated previously, this is a very general overview of some of the types of anesthesia used in orthopedic surgery. Your orthopedic surgeon and/or your anesthesiologist may have a specific preference for your upcoming surgery. I am not an anesthesiologist! This is simply an overview guide, and all of these types of anesthesia have their own risks that you must discuss with your anesthesiologist. He or she will be able to work with you to identify safe and appropriate anesthesia for your upcoming surgery.
References:
Anesthesia: A look at local, regional and general anesthesia Mayo Clinic Foundation, Last Updated: June 16, 2006.
Image © Nancy Louie
Knee replacement surgery has become quite common, but there are still risks. Fortunately, well over 90% of patients who undergo knee replacement surgery have good results.
You should have a thoughtful discussion with your doctor prior to total knee replacement surgery and make sure to have your questions answered.
Questions to ask before knee replacement surgery You must understand the potential risks: Blood Clots Blood Loss Infection of a Joint Replacement Stiffness of the Knee Replacement
Lie on your back with your knees bent in a 10 to 15 degree angle. Without moving your leg, pull your heel into the floor. This will cause the muscles on the back of your thigh to contract. Hold this for five seconds. Relax and repeat 10 more times. Prev Post Knee Arthroscopy ExercisesExercise 1 – Quadriceps Contraction Exercise 2 – Hamstring Contraction Exercise 3 – Gluteal Sets Exercise 4 – Straight Leg Raises” rel=”next”>Nextfunction zIt2t(C,F){if(C.getElementsByTagName(“a”)[0]){C=C.getElementsByTagName(“a”)[0];var A=document.createElement(“div”);A.className=”tt hide”;A.onmouseover=function(){if(to){window.clearTimeout(to)}};A.onmouseout=function(){sf=this;if(to){window.clearTimeout(to)}to=window.setTimeout(“sf.parentNode.lastChild.className = ‘tt hide’;”,500)};var E=document.createElement(“p”);var B=document.createElement(“a”);B.href=C.href;B.setAttribute(“zT”,C.getAttribute(“zT”));var D=document.createTextNode(C.title);A.appendChild(E);E.appendChild(B);B.appendChild(D);if(C.parentNode.appendChild(A)){C.onmouseover=function(){sf=this;if(to){window.clearTimeout(to)}var I=getElementsByClassName(“tt”,gEI(“pagination”));for(var H=0;H
Most often, you hear of hip osteoarthritis or knee osteoarthritis. However, other joints are common sites of osteoarthritis as well. For example, facet joint osteoarthritis causes pain, stiffness, and lost motion in the back.
The facet joints are located on the back of the spine. Between each pair of vertebrae, there are two facet joints (one on each side of the spine). A facet joint is comprised of two bony knobs. Where the knobs come together, they connect two vertebrae. The surfaces of the facet joints are covered by articular cartilage.
Facet joint osteoarthritis is caused by the breakdown of the articular cartilage. Previous fractures and injuries can cause facet joint osteoarthritis later in life, but the main cause is spinal degeneration, which occurs slowly over time.
Pain is the primary symptom associated with facet joint osteoarthritis. Symptoms of nerve compression usually do not occur with facet joint osteoarthritis. However, when a bone spur develops at the edges of the facet joint, it can rub on a nerve and cause numbness, tingling, and muscle weakness.
As with most arthritic conditions, facet joint osteoarthritis is diagnosed following a physical examination, medical history, and x-rays or other imaging studies. The images will show degeneration of the spine and facet joints, as well as bone spurs around the affected facet joint.
Your doctor may also perform a diagnostic injection (using special dye and a fluoroscope) to precisely locate where the pain is coming from. In such cases, numbing medication is injected into the facet joint or the nerve going to the facet joint.
The goal of treating facet joint osteoarthritis is to reduce pain and inflammation. Short periods of rest are helpful. Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxers, and even tapering doses of steroids are used to control symptoms.
Certain exercises and body positions can take pressure off the facet joints. A physical therapist can help you learn positions and exercises that offer relief.
Facet joint injections of an anesthetic or steroid medication are a possibility if you are not finding relief with other conservative treatments.
Surgery is rarely needed, but there are two procedures used when necessary. Facet rhizotomy is a surgical procedure that involves severing a small nerve that goes to the facet joint. Fusion can be performed to join two vertebrae for the purpose of stopping movement of the facet joint — but multilevel fusions are typically not recommended.
Sources:
Facet Joint Arthritis. Orthogate. July 28, 2006.
http://www.orthogate.org/patient-education/lumbar-spine/lumbar-facet-joint-arthritis.html
Monday February 23, 2004 Training to become an orthopedic surgeon is a process that requires four years of medical school, five years of residency, and may require optional education for subspecialty work. For … Read More PermalinkComments (0)Share Next
I’ve been on varying amounts of prednisolone since last October (2009) and I was in hospital with bulleous vasculitis, cellulitis and infections in my legs. It’s healed up now but I have leg ulcers which are finally healing up too now after 10 months. I started off on 60ml, then went down to 40ml, back up to 60ml and again down to 40ml and I’ve been reduced within the last month to 20ml daily. I went up to 18.5 stone, got the moonface, fingers and ankles all swollen too. I’ma 27y/o male. I’ve lost 5 pound recently using nothing but the wii fit over a few days and I’ll be continuing it as well as watching the calories – it’s slow going, but I’m sure the weight will drop off. Good luck to everyone else!—Guest El
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When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create surfaces that can accommodate the implant perfectly. A metal and plastic knee replacement implant is then placed in to function as a new knee joint. Depending on the condition of the cartilage underneath the kneecap, the kneecap surface may also be replaced.
How are the replacement implants held in the bone? Can both knees be replaced in one operation? Minimally Invasive Knee Replacement Computer-Assisted Knee Replacement
Definition:
The septum is the cartilage wall that separates the nasal passages into two separate nostrils. The septum should be centered dividing the nostrils evenly. If the septum leans to one side or the other, it is deviated.
Deviated septum can be caused by trauma or it can be congenital. When the septum is deviated, it can block airflow through one of the nostrils.
The principle of joint protection is self-explanatory. You can protect your joints by using assistive devices, wearing supports, using better body mechanics such as using large joints rather than small joints, and resting the joints. By not adhering to these principles of joint protection, you risk increasing your pain and damaging your joints.
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