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Can Knee Surgery Be Done Under Local Anesthesia

What Are The Potential Side Effects Of Anesthesia

MoraMD: Local Anesthesia for Knee Arthroscopy, Yes its Possible : Dr Mora

Most anesthesia side effects are temporary and go away within 24 hours, often sooner. Depending on the anesthesia type and how providers administer it, you may experience:

  • Back pain or muscle pain.
  • Chills caused by low body temperature .
  • Difficulty urinating.
  • Pain, tenderness, redness or bruising at the injection site.
  • Sore throat .

How Does Anesthesia Affect Pregnancy

Local anesthesia affects a small area of the body. Its considered safe for pregnant or breastfeeding women. Many pregnant women safely receive regional anesthesia, such as an epidural or spinal block, during childbirth. Your healthcare provider may recommend postponing elective procedures that require regional or general anesthesia until after childbirth.

Can Knee Lifts Be Done Under A Local Anesthetic

Q: Dr. Eppley, I am interested in knee lifts. I am 50 years old and am very active but my knees look like an 80 year old women. I need a knee lift to regain my KNEE self-esteem. I am in disbelief as active as I am that my knees have aged so horribly. I have an adverse reaction to most anesthetics so hopefully this is a procedure which could be done under a local anesthetic.

A: The knees, like any other structure on the body, are not immune to the aging process. the constant motion across the knee joint requires moveable flexible skin. But for some people that constant motion results in the development of loose skin. This loose skin appears as folds above the knees, often having two or three small skin folds that have piled up above the knee cap.

The procedure of a knee lift can remove these skin folds by excising a crescent of skin above the patella. It must be marked and removed carefully so that enough skin is left for the knee to bend 90 degrees of greater without undue pulling on the wound closure/scar. It is a fairly simple outpatient procedure that for the very motivated could be done under local anesthesia. It does result in a fine line scar above the knee and this must be considered carefully as a worthwhile aesthetic trade-off for the removal of the suprapatellar skin folds.

Dr. Barry Eppley

Recommended Reading: How To Stop Limping After Knee Surgery

Recovering From An Arthroscopy

How long it takes to recover from an arthroscopy depends on the joint involved and the specific procedure you had.

It may be possible to return to work within 7 days if your job involves sitting at a desk, but if it’s more physical, you may need to stay off work for up to 2 weeks.

You may not be able to do more demanding physical activities, such as lifting and sport, for several months.

Your surgeon or care team will let you know how long it’s likely to take to recover and what activities to avoid until you’ve fully recovered.

While recovering, contact your GP or surgical team for advice if you think you may have a complication, such as an infection or blood clot.

Read more about recovering from an arthroscopy.

Top 10 Reasons For Staying Awake During Hand Surgery

Can Arthroscopic Knee Surgery Be Done Under Local ...

Many hand surgery procedures can now be performed under local anesthesia in the clinic setting, without the need for sedation or general anesthesia, using a technique called WALANT, which stands for wide awake local anesthesia no tourniquet. While it might seem counterintuitive to go through surgery while being awake, there are some proven benefits. More to come on that below. First, a couple FAQs.

Q: What procedures can be performed with the WALANT technique?A: The procedures include:

  • Removal of excess tissue

Q: How do I know if I am a candidate for the WALANT technique?A: In most cases, the you will visit with the hand surgeon to determine if surgery is appropriate and if WALANT is right for you.

There are many advantages of using the WALANT technique. These include:

  • Less pain Patients no longer require use of a tourniquet on the upper arm to control bleeding or require an IV.
  • It is much less expensive to use this procedure.
  • Quicker recovery time You do not have to wake up or have the groggy feeling after surgery that can occur with sedation or general anesthesia.
  • Sooner return to normal activities With no sedation, you can get back to your normal routine faster.
  • No fasting before the procedure You can eat and drink as usual.
  • Shorter wait time You can get the surgery done sooner as there is no need to schedule around an operating room availability.
  • Avoidance of potential side effects and complications You can avoid surgical side effects, such as nausea.
  • Also Check: How To Lighten Your Knees Overnight

    Why Regional Anesthesia Is Often Better

    A number of studies have looked into different risks of joint replacement and how anesthetic choice influences the chances of complications. Regional anesthesia has consistently shown better outcomes than general anesthesia across a range of areas:

    • Lower 30-day post-operative mortality rate
    • Fewer medical complications
    • Lower infection rates
    • Less blood loss
    • Less need for post-operative pain medications like opioids
    • Shorter operating room procedure time
    • Shorter hospital stays: One study of nearly 11,000 joint replacement patients found regional anesthesia patients spend a full day less in the hospital .

    All of this adds up to lower surgical risks, shorter recovery times, and lower overall medical costs.

    What Are Some Types Of Knee Surgery

    The most common knee surgeries involve arthroscopy â a surgical technique used to repair many different types of knee problems â or knee replacement.

    Arthroscopic surgery

    Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patientâs body through small incisions.

    For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeonâs work. Surgical instruments are inserted into the joint through a second incision.

    The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:

    • Removal or repair of a torn meniscus â a type of cartilage in your knee that cushions and stabilizes the joint
    • Reconstruction of a torn anterior cruciate ligament , which is a ligament that helps stabilize the knee joint
    • Removal of inflamed synovial tissue
    • Trimming of damaged articular cartilage
    • Removal of loose fragments of bone or cartilage
    • Treatment of patella problems
    • Treatment of knee sepsis

    Knee replacement

    In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.

    Recommended Reading: Can You Rebuild Cartilage In Your Knee

    L Does The Patient Have Any Antibiotic Allergies

    Since antibiotics are commonly administered when performing knee arthroscopies, a history of allergic reactions to these medications must be elicited. The usual antibiotics used will cover skin flora. The most commonly used antibiotic is ancef, a cephalosporin. If the patient has never been exposed to cephalosporins in the past a history of penicillin allergy should be sought since there is an incidence of cross sensitivity. If the patient has a history of penicillin allergy but no prior cephalosporin exposure, a decision need be made as to the risk of an allergic response to the ancef versus the benefit of its bacterial coverage. If the patient has a documented cephalosporin allergy, a different class of antibiotic should be used. Alternative antibiotics include clindamycin and vancomycin.

    Did You Know That The Use Of Regional Anesthesia For Total Knee Replacement Surgery Isnt All That Uncommon

    Knee Arthroscopy Under Local Anesthesia- Awake Surgery by Dr Mora

    General anesthesia brings with it fear in many people that theyll never wake up.

    Dont let the fear of general anesthesia stop you from pursuing total knee replacement surgery if your knee has reached a point of hopelessness with conservative treatment.

    Yes, there are surgeons who use regional anesthesia to perform total knee replacements.

    Now that you know that, its very logical to wonder why this approach isnt utilized more often than general for knee replacement surgery, since the risk of dangerous blood clots is less with the regional.

    A blood clot that results from surgery is called a deep vein thrombosis . A DVT can break loose and migrate to the lungs and kill a patient.

    In general, the risk of DVT is slightly higher with general anesthesia than with regional, says orthopedic surgeon David Fisher, MD, Director of the Total Joint Center at the Indiana Orthopedic Hospital. With prophylaxis of anticoagulation, the risk is between 1-2%.

    Anticoagulation refers to the use of blood thinning drugs. The risk with regional tends to be on the lower side.

    Thus, there is no doubt that regional anesthesia wins over general for knee replacement surgery as far as yielding a lower risk of DVT development.

    Read Also: When Can I Shower After Knee Replacement Surgery

    How The Operation Is Done

    Knee replacement surgery is usually performed either under general anaesthetic or under spinal anaesthetic or epidural .

    The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts which have been measured to fit.

    You may have either a total or a partial knee replacement. This will depend on how damaged your knee is. Total knee replacements are the most common.

    Read more information about what happens on the day of your operation.

    J How To Modify Care For Patients With Known Allergies

    Patients presenting for knee arthroscopy are treated no differently than patients presenting for other types of surgery in terms of known allergies. Triggering agents must be avoided. Allergies that are significant in relation to anesthetics for knee arthroscopy are those to tape, antibiotics, local anesthetics, pain medications, and soy or egg products .

    Patients allergic to tape should be queried about the specifics of their allergy. Often there is a specific type of tape that the patient is allergic to allowing the safe use of other, non-allergic reaction producing, tape to be used. If the history is unclear, the use of an LMA without being secured by tape is an option. If an endotracheal tube is used, tracheal ties are reasonable options.

    Patients are usually given prophylactic antibiotics for these procedures. The primary organisms being covered are skin flora. A cephalosporin is used to provide protection against these organisms. Patients allergic to cephalosporins, and those allergic to penicillins , can receive clindamycin or vancomycin.

    If a patient receives a regional technique for his/her anesthetic it is often combined with sedation. The most common agent used is propofol. Propofol is also commonly used as part of a general anesthetic. Occasionally a patient is allergic to soy or lecithin and, therefore, should avoid this medication. Alternatives to propofol sedation include dexmedetomidine, versed, and ketamine.

    Read Also: Nano Knee Cost

    But Regional Anesthesias Advantage Over General Doesnt End There

    Additional benefits from the regional include better postoperative pain control, and decreased anesthesia side effects , continues Dr. Fisher.

    Regional options include peripheral nerve blocks, spinal anesthetic, and epidural anesthesia.

    Depending on the hospital and anesthesiologists abilities or competency at administering regional anesthesia, local physicians may have preferences.

    If a patient wanted regional anesthesia, I would think the surgeon would be agreeable to having it provided.

    Dr. Fisher has been involved in research and development of total hip and knee implants and has had numerous articles published in professional journals, and has participated in many research projects.
    Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. Shes also a former ACE-certified personal trainer.

    Differences Between General And Regional Anesthesia

    Arthroscopic Lysis of Adhesions and Anterior Interval ...

    General anesthesia completely sedates a patient , using a ventilator machine to aid breathing. This is anesthesia in the classic sense and what most people think of when discussing surgery.

    Regional anesthesia in joint replacement usually involves an epidural injection in the lower back that numbs the lower extremities . This is the same anesthesia given to some women during childbirth.

    Regional anesthesia also allows a patient to adjust their level of sedation during a surgical procedure, depending on their comfort. They can breathe without the aid of a machine during their procedure.

    Regional anesthesia is not the same as local anesthesia. A “local” numbs only a small area for minor procedures . A regional numbs a much larger area for major procedures.

    Recommended Reading: Nano Knee Procedure

    What Determines Your Anesthesia Type

  • Your History: Have you ever had general anesthesia? If so, did you react well? Do bad reactions to general anesthesia run in your family? If you have had any bad reactions to general anesthesia in the past, it may not be the preferred choice for you.
  • Your Health: General anesthesia is more risky than regional anesthetic. For this reason, if you are entering a surgery with additional risk factors than you may not be a candidate. A clean bill of health is recommended for general anesthesia .
  • Your Care Team: Just like your orthopedic surgeon has preferred implant brand manufacturers he/she works with and preferred approaches for hip replacement surgery, he/she will have a preferred method of anesthesia. This may differ based on each patients profile, but your surgeon will guide you toward the anesthesia method that they want for you.
  • Your Preference: If you feel very strongly toward general vs. regional, your care team will certainly take this into account. If youre scared of needles, you may prefer general anesthetic. If youre scared of the idea of being put under, then you may prefer regional.
  • Another contributing factor is whether or not youre having inpatient or outpatient joint surgery. Regional anesthesia has a faster bounce back so is often preferred in outpatient joint replacement surgery. Continue reading to learn more!

    Laparoscopy: No General Anesthesia

    Laparoscopy without general anesthesia

    Laparoscopy without general anesthesia under regional anesthesia

    In February 2009 I went to my gynecologist for cancer screening. During the ultrasonic testing she found a cyst on the right ovary. Six weeks later the cyst was still there. It had expanded. Now the size was about 4 to 5 centimeters. Therefore a more detailed medical check-up, a laparoscopy, became necessary and I was admitted to a hospital in my hometown. At the time I had no clear idea about the laparoscopy. I hoped that it could be comparable with an arthroscopy of knees and could be done without general anesthesia. My gynecologist couldnt tell me anything about the type of applied anesthesia. Therefore I searched for information in the Internet and called the hospital. My fears were confirmed. Because of the application of gas, laparoscopy would only be done there with general anesthesia.

    My dislike for general anesthesia is strong. I would only accept it, if there were no other possibility. I also had good experience with localanesthesia.That is why I searched the internet again. I searched feverishly for another solution. Finally I found the homepage of EndoGyn. I was relieved to find the following information:

    I would like to give my sincere thanks to Dr. Kruschinski and his team. I would again decide in favor of surgeryby him and using the localanesthesia process anytime.

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    Surgery For Prepatellar Bursitis

    What is prepatellar bursitis? How can you decrease the knee swelling and pain? When is surgery needed for this condition?

    Cindy asks:

    I had my right kneecap drained three times. Now it has a ball about the size of a large marble on top. Its very hard. It is painful only if I run or walk a distance. Its ugly to look at. Should I see about having it removed and can it be removed under local anesthesia?

    G Additional Systems/conditions Which May Be Of Concern In A Patient Undergoing This Procedure And Are Relevant For The Anesthetic Plan

    Local Anesthesia for Knee Arthroscopy: How I do it- from Dr Steve Mora

    Since regional anesthesia, either neuraxial or peripheral nerve blocks, is frequently used as the anesthetic for knee arthroscopy, one must be careful when dealing with patients with clotting abnormalities. Most commonly, the clotting abnormalities are secondary to medications, which will be covered in a later segment. On occasion, the anesthesiologist will be dealing with a patient who has a genetic deficiency in a clotting factor. These patients will be at risk for intra and post-operative bleeding. Usually the patient will already have been identified and followed by a hematologist. A close working relationship needs to be developed between the hematologist and the anesthesiologist. Recommendations should be obtained regarding which factor need to be transfused, how much of each factor and amount, and frequency of post-operative transfusions. In addition, recommendations will be made with respect to the number of days the transfusions must be continued. With such coordination, patients with significant inborn errors of coagulation can be safely guided through surgery.

    Patients who have never had an operation, but have a suspicious history for a bleeding disorder, would be well served by being seen in consultation by a hematologist. This may postpone elective surgery, but could potentially spare the patient significant post-operative morbidity.

    Read Also: How To Reduce Swelling After Knee Replacement

    What Type Of Anesthesia Should I Use

    Your choice of anesthetic depends on many factors, such as the surgery being performed, your risk factors, and your preferences. Your choice may affect the risk of complications, cost, and time spent in the medical facility. It also may affect how quickly you can begin physical therapy.

    Always consult with your physician anesthesiologist on the best option for you.

    • Regional anesthesia is a common option for arthroscopic surgery. It numbs only the area of the body that requires surgery. You remain awake and aware. Regional anesthesia includes spinal or epidural anesthesia and peripheral nerve blocks. Some research has found that regional anesthesia can provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
    • Local anesthesia may be an option for arthroscopic surgery, although it is less commonly used. A one-time injection numbs just a small area around the surgical site. Advantages to local anesthesia include lower risk of complications, lower cost, and faster release from the medical facility.
    • General anesthesia, which renders you unconscious during surgery, is sometimes used for knee replacement. But regional anesthesia can also be an option for this surgery.


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