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Tuesday, September 30, 2014
Spinal anesthesia for hip surgery - safe?
I need a total hip replacement and the surgeon I`ve seen says he uses spinals for surgery. I`ve heard bad things about this and wonder how safe that kind of anesthesia is.
Thanks for your question. You can rest assured that spinal anesthesia is a safe choice for hip surgery. Many patients when offered this type of anesthesia are concerned about serious side effects, such as paralysis, and also about troubling but less dangerous side effects, such as headache. There seems to be a common, although false, perception that these complications occur often. In fact, spinal anesthesia has a long track record of safety, with a rate of serious complications (low!) about equal to the rate of major problems with general anesthesia (also low!). Studies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not found a completely convincing advantage of one over the other, and therefore both types of anesthesia are commonly used. In our hospital, at least half of the hip replacement surgery is done with spinal anesthesia. Among the reasons it is favored, include: (1) more rapid recovery of mental function, (2) the lack of need for insertion of breathing tubes, (3) the lower incidence of nausea or vomiting, and (4) the prolongation of anesthesia after completion of surgery, which means a longer pain free period. Paralysis after spinal anesthesia is very rare. The number of patients who develop a headache is also quite low – in expert hands and using appropriately sized (small) needles, fewer than 1% or so of patients should have a headache. Although a “spinal headache” is troublesome, it is not life-threatening. Not all patients are candidates for spinal anesthesia. We do not offer this technique to patients who are at risk for internal bleeding problems or to patients with infection in the area where the needle is inserted. In our hospital, we try to offer a realistic explanation of the different anesthetic techniques, their risks and benefits. Assuming there is not an absolutely compelling reason to choose a particular technique, we usually allow the patient to make a choice. It is best for you to have this discussion with your anesthesiologist, the physician who will be responsible for this aspect of your care.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University