Anaesthesia for Orthopaedic Surgery

By far the most common joint examined by orthopaedic surgeons using the arthroscope is the knee joint. However, other joints that can be examined and operated on arthroscopically include the wrist, elbow, ankle and shoulder.

An arthroscope is a long, thin, rigid telescope which the surgeon inserts into the joint to visualize mechanical damage to the joint surfaces and cartilage. The surgeon can then operate using other small instruments inserted into the joint to correct and repair this damage. During the operation the joint is distended with saline to improve the view of the joint. Arthroscopic operations (except shoulder arthroscopies) are performed with a tourniquet applied to the limb to prevent blood obscuring the surgeon's view.

Most arthroscopic procedures are performed under general anaesthesia. A general anaesthetic (fully asleep) is started with a needle in the back of the hand or in the arm. An airway tube is inserted into your throat when you are asleep. This may leave a 'funny' feeling or taste in your throat for a short time after you wake up. The amount of anaesthesia given is tailored to let you be wide-awake to go home the same day in most cases. For shoulder arthroscopy in some cases a tube is inserted into your windpipe once you are anaesthetised.

Occasionally for knee and ankle arthroscopy a spinal anaesthetic is given. A spinal anaesthetic involves the injection of local anaesthetic into the spinal fluid using a very fine needle. This temporarily numbs the body from the waist down and stops leg movements. The effect lasts several hours and gradually wears off. There is no pain from the operation while the 'spinal' is working. An intravenous drip and heart and blood pressure monitoring are all started beforehand as blood pressure may decrease a little because of the 'spinal'. Sedation is usually given during the operation. Very rarely you may develop a nasty headache after a 'spinal' - even further minimized by bedrest in hospital until the next day. For this reason a spinal is not usually offered if you intend to go home the day of surgery.

Your anaesthetist will prescribe a suitable strong analgesic for you post-operatively.

As with all anaesthetics, it is important that you do not drive a car, operate any complicated machinery or sign legal documents for 24 hours after your operation finishes.

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