Anesthesia: How To Get It Right

Anesthesia scares many patients more than the actual surgery.

In fact, no one really understands anesthesia. Why do some drugs make people feel no pain and experience no obvious consciousness—yet they can sometimes remember words spoken in the operating room? That said, many parts of the anesthesia experience can be optimized, at least from this orthopaedic surgeon’s point of view. Here are a few tips we have learned over the years.

Have no pain: This is the primary goal for my patients. I want them to be pain-free but with the least amount of drugs necessary. This way they can be awake, alert, free of nausea, and able to exercise their post-operative extremity even while in the recovery room bed and the next day. To get there, several steps must happen.

First, patient preparation. Knowing that I will ask you to move your body parts as soon as possible, and meet with your physical therapists and trainers the next day, sets the stage.

Second, preemptive anesthesia. This means that I will inject local numbing medications into the area of injury before any incision is made. I don’t want your brain, even if you are asleep, to feel pain. And I want these medications to be as long-lasting as possible—preferably, days. If you don’t wake up in pain, when the ache does come on it is much easier to tolerate than if you start out in discomfort and pissed off.

Third, reducing the use of narcotics. The drugs used by anesthesiologists today are so short-acting and so effective that when we combine them with intra-operative anti-inflammatory medications such as ketorolac (Toradol) and intravenous acetaminophen (Tylenol), the need for narcotics in surgery and afterward is diminished. Narcotics are nauseating and dysphoric, meaning they help you ignore the pain, but you still have it. If we can avoid them, we do.

Fourth, regional blocks. Whenever we can we use nerve blocks either to avoid general anesthesia completely (most shoulder cases can be done this way) or to reduce the amount used. Adductor blocks for the knee joint, regional blocks for the ankle, and interscalene blocks for the shoulder are almost always applied.

Fifth, general versus spinal anesthesia is a discussion we leave to the anesthesiologist. Patients have different health issues and different preferences, and this choice is usually best decided by the expert who is administering the drug.

Lastly, new long-acting pain drugs mixed with anti-inflammatory medications (Zyn Relief) are gels that we can place into the tissues when doing open surgery cases. All of our partial and total knee replacements get these compounds, and as a result the patients often have no pain for several days. This is a game-changer for many people, as they can walk with full weight-bearing immediately after surgery and drive soon thereafter.

So when talking about anesthesia, “no pain, all gain” is what the doctor ordered, and what the patient loved.