specific SuRGERY INFORMATION
Hip and knee replacement
If you are having a hip or knee replacement, I will review your health and plan your anaesthetic and pain relief with you before your surgery.
Modern joint replacement care uses an enhanced recovery approach, combining careful preparation, modern anaesthetic techniques and effective pain relief to help you recover from your operation.
Further information
Australian and New Zealand College of Anaesthetists
Australian Society of Anaesthetist
Your anaesthetic and enhanced recovery
Enhanced recovery aims to help you recover from surgery safely and efficiently while reducing some of the unwanted effects of surgery and anaesthesia.
From an anaesthetic perspective, this means preparing carefully before surgery, avoiding unnecessary fasting and dehydration, choosing an appropriate anaesthetic, and using several forms of pain relief together.
01
Prepare
Review your health, medications and anything that may affect your anaesthetic or recovery.
02
Hydrate
Avoiding unnecessary dehydration is an important part of enhanced recovery.
If you are eligible for Sip Til Send, you are encouraged to continue drinking permitted clear fluids while fasting and to have a clear electrolyte drink before admission to help you arrive well hydrated for surgery.
03
Anaesthetise
Choose an anaesthetic appropriate for you and your operation, while minimising unwanted effects that may interfere with your recovery.
04
Control pain
Use several different types of pain-relieving medications together to provide effective pain relief while reducing reliance on opioids.
Preparing for your surgery
Preparing in advance gives me an opportunity to understand your health, review your medications and plan the most appropriate anaesthetic for you.
01
Complete your questionnaire
Complete your pre-operative questionnaire as early as possible so I can review your medical history, medications and previous experiences with anaesthesia before your assessment.
Complete questionnaire →
03
Your pre-operative assessment
I will review your health with you before your operation. This may take place in person or over the phone.
We will discuss your anaesthetic and pain relief, and any medical conditions or previous experiences that may affect your care.
Depending on your health, you may need additional tests or review by another specialist before your surgery.
05
Stay hydrated before surgery
Avoiding unnecessary dehydration is part of preparing for your anaesthetic.
Your hospital will give you specific instructions about when to stop eating and what you may continue to drink. Many patients can continue drinking permitted clear liquids while fasting through Sip Til Send.
You may also be advised to have a clear electrolyte drink before admission.
Fasting and Sip Til Send →
02
Check your medications
Make sure your medication list is up to date. Most medications can be continued, but some need specific instructions before surgery, particularly blood-thinning and diabetes medications.
Do not stop prescribed medications unless you have been specifically advised to do so.
Medication information →
04
Plan your pain relief
Your pain relief is planned before your operation and is an important part of enhanced recovery.
I use several different types of pain relief together to provide effective pain control while reducing reliance on stronger opioid medications. The exact plan will be tailored to you and your operation.
How your pain will be managed →
06
Tell me if something changes
Please let me know if there is an important change in your health before your operation, particularly if you become unwell or develop a new medical problem.
Also let me know about any significant changes to your medications.
This may affect your anaesthetic or whether any further assessment is needed.
Your anaesthetic
Your anaesthetic will be planned around you, your operation and your health. The aim is to provide safe anaesthesia and good pain relief while minimising unwanted effects that could interfere with your recovery.
I will discuss the planned approach with you during your pre-operative assessment.
Knee replacement
For knee replacement surgery, I will usually perform an adductor canal block as part of your anaesthetic.
This involves an injection of local anaesthetic around nerves in the thigh to provide pain relief after your operation.
You will then usually have a general anaesthetic for the operation. Your surgeon will also inject local anaesthetic around the surgical area to provide additional pain relief.
Hip replacement
For hip replacement surgery, you will usually have a general anaesthetic.
Your surgeon will also inject local anaesthetic around the surgical area during the operation to help with pain relief afterwards.
Your anaesthetic will be adjusted to your individual needs throughout the procedure.
Regional anaesthesia and nerve blocks
For knee replacement, a nerve block can provide targeted pain relief as one part of your overall pain-management plan.
What is a nerve block?
A nerve block is an injection of local anaesthetic around specific nerves to numb part of the body and provide pain relief.
Ultrasound may be used to help locate the nerves and guide the injection accurately.
What will my leg feel like?
After a nerve block, your leg may feel numb, heavy or tingly. Movement may also be reduced while the block is working.
These effects gradually wear off as the local anaesthetic wears off.
Pain relief and enhanced recovery
Good pain relief is an important part of recovery after joint replacement surgery. The aim is to keep your pain manageable so that you can rest, move comfortably and take part in your recovery.
Several different types of pain-relieving medications are usually used together. This is called multimodal analgesia. Each medication works in a different way, helping to provide effective pain relief while reducing the amount of opioid medication you may need. This opioid-sparing multimodal approach is specifically identified as part of enhanced recovery for hip and knee replacement.
01
Paracetamol
It works best when taken regularly rather than waiting until your pain becomes severe.
After joint replacement, I usually recommend continuing regular paracetamol during the early part of your recovery.
02
Anti-inflammatory medications
Anti-inflammatory medications reduce pain and inflammation in a different way to paracetamol.
Celecoxib is commonly used while you are in hospital if it is suitable for you. After discharge, an anti-inflammatory medication may continue to form part of your pain-relief plan.
These medications are not suitable for everyone, particularly if you have certain kidney, stomach or cardiovascular problems, so only take them if they have been recommended for you.
03
Magnesium
Magnesium may be used as an additional part of your pain-relief plan.
It works differently from your other pain-relieving medications and is used alongside, rather than instead of, paracetamol and other medications.
I commonly use magnesium as part of my multimodal pain-relief approach after joint replacement surgery.
04
Opioids
Opioids provide stronger pain relief when you need it.
After joint replacement, medications such as oxycodone or immediate-release tapentadol may be used for pain that is not adequately controlled by your other medications.
Opioids can cause side effects including nausea, drowsiness and constipation. As your pain improves, you should usually need them less often. The aim is to use the lowest amount needed for the shortest time necessary, while continuing your other pain-relieving medications as directed.
Why use several types of pain relief?
Using medications that work in different ways can provide better overall pain relief while reducing reliance on opioids.
Think of your regular medications as the foundation of your pain relief, with stronger opioid medication available when you need additional relief.
This approach can help you remain comfortable enough to rest and participate in your recovery while reducing opioid-related side effects.
After your operation
At the end of your operation, you will be taken to the recovery area where nursing staff will monitor you as you wake from your anaesthetic.
Your pain, nausea and other effects of the anaesthetic will be assessed and treated as needed before you move on to the next stage of your recovery.