Regional Anesthesia Pathway for Patients

For hip replacement surgery we use specific steps to optimize the outcome and experience of our patients scheduled for hip replacement surgery. Once in the N-block room, these specific steps will consist of the administration of spinal anesthesia (tailored to your health condition), and an additional regional anesthesia procedure to control the pain after the operation.

  • Spinal anesthesia: This type of anesthesia is intended to temporarily interrupt sensation from the trunk and legs by injection of numbing medication (i.e., local anesthetic) into the back around nerves supplying the spine. 

For the procedure, you will be placed either on your side or sitting. One of the nurses will give you oxygen through a face mask. This is routine for all patients receiving any type of anesthesia. Medication will be given through your IV to relieve tension and anxiety, if necessary.

The anesthetist will then examine your back, and clean the skin on your back with an antiseptic (bacteria-killing) solution, and place sterile drapes. The anesthetist will let you know verbally before administering a small amount of medication to the skin of the lower back to numb the skin. The patients report that it feels like a small pinch and/or minor burning or pressure sensation on the skin where the medication is given. 

Your anesthetist will then skillfully insert the spinal needle to reach the correct place for the injection of the numbing medication. You should not worry about the safety of this procedure, as your anesthetist is extremely well trained to do this, and we perform thousands of spinal anesthesia procedures every year without complications. During the needle placement, you may feel a tingling sensation in the area of the hip or down the leg. 

After injection of the medication, you will begin to feel warmth in your legs, followed by a loss of sensation from the waist down to your feet. Consequently, you will also lose the ability to move the anesthetized area (i.e., your thighs, legs, and feet). This is normal. Approximately 5-30 minutes after the injection, the spinal anesthesia will take full effect. Duration of your spinal anesthesia depends on the type and amount of local anesthetic medication used by your anesthetist, typically 1.5-5 hours. Once the medications wear off, you will regain sensation and movement. 

Nerve block for pain after the operation: At NYSORA CREER, ZOL Center, we routinely use ultrasound-guidance for nerve blocks to assure efficacy, and decrease the pain after the operation and time to recover. The two procedures we routinely use in patients having hip replacement surgery are suprainguinal fascia iliaca block and a hip block. These are somewhat similar but their specifics mandate selection for each patient. Your anesthetist will make a decision on which one is best for you. Whatever the choice, you will not feel any discomfort during the block placement as your spinal anesthesia will block the pain. Operating room 

After the spinal anesthesia and the nerve block has been performed, you will be transferred to the operating room. Here, you can choose to remain awake, listen to calming music through headphones, or be given additional medication to help you sleep lightly during the surgery. 

After the surgery, you will be taken to the recovery room and monitored closely until your spinal block wears off (meaning when you are able to feel and move your hip and legs). Once recovered, you will be transferred to your room. Once you are in the room, do not attempt to walk by yourself or get out of bed without assistance. The operated leg may still be weak due to the surgery or numbing medications and you may fall. Your ability to walk safely and start rehabilitation will be guided by our team of physical therapists. 

Going home

Most of our patients receiving hip replacement can go home the same day of surgery. However, some patients need to stay one night in the hospital for health-related reasons. Throughout the preparation for your operation and recovery, you will be guided by our HIP COACH who consults with our team of doctors, nurses and rehabilitation specialists, so that you always know what to expect and what you should do next.