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TOTAL HIP REPLACEMENT ANAESTHETIC AND DRUGS

YOUR TOTAL HIP REPLACEMENT OPERATION - ANAESTHETIC AND DRUGS

I am not a doctor, and the following information is based on personal experiences in mountain rescue and personal experiences with two total hip replacement operations and a further operation to re-attach a ripped quadriceps tendon. By all means use this information to help you to make a choice, but consult expert medical help before making your final decision as my experiences might be different from yours.

1. ANAESTHETIC DURING THE OPERATION.
It seems to be standard practice to use a spinal injection, which numbs your body totally for 3-6 hours, downwards from the injection site.
I have had 2 spinals, the second of which produced relatively severe problems, enough to make me change method for the third op. The spinal I believe usually injects diamorphine as one of the painkillers. All morphine based products can have side effects and for my last operation I decided to make it morphine/opiate free.

The problems I had with the spinal injection and with morphine included:
- Severe back pain following the operation which lasted for about 3 weeks and which was worse than the pain in the operated hip
- Severe rash and itching from thighs to chest, especially when I lay down, due to histamine being released by the cells, a a result of the morphine. This lasted for 3 weeks
- Severe Depression following being on morphine for several days
- Generally feeling unwell, nauseous and dizzy

Fo my second hip replacement I asked about alternatives and a combination of a general anaesthetic and an epidural was advised as an alternative to a spinal. This is what I had. Recovery from the general anaesthetic was OK. The epidural however did not work correctly. It only numbed the right side of my hips and legs, when it was the left which was painful!! It is a risk that it will not work fully, due to the difficulty in releasing the anaesthetic into exactly the correct location. Had it worked correctly it would have removed the pain, but with the downside that you have no movement or feeling in your hips and leg.

Conclusion? Ask you anaesthatist about the different options and be comfortable with what you are offered and what you accept. Some leading private centres offer a lower dosage spinal and a 'light' general anaesthetic, but I have no experience of this. Certainly if you have any problems with opiates, or if you just don't want to expose yourself to their potential side effects, don't have a conventional spinal aneasthetic.

2. POST OPERATION PAINKILLERS
If you had a spinal, this will continue to work for some time after the operation, but you will need to take additional painkillers. If you have an epidural, your leg will (hopefully) be numbed, but when you come off this, you will need additional painkillers. My experience of a range of painkillers is described below - but please remember that this is very personal, and you should only make choices after consulting appropriate medical advice as well.

MORPHINE DRIP - Standard painkiller and very effective, plus is self administered to a point. I found all morphine related products gave me significant side effects as described previously and for my second hip replacement I decided to be morphine free. As a result I came out of hospital in a much more positive and alert mental state.

OTHER MORPHINE/OPIATE BASED DRUGS
You will probably be offered a range of other opiate based drugs orally. They almost invariably will kill pain, but may leave you feeling nauseous/dizzy and drowsy. You may also experience hallucinations. From my experience of taking the drug, and from seeing other people's reactions to it, I would strongly advise you not to take Tramadol. Aside from potential addiction problems if it is taken for a more prolonged period post-op, it had unpleasant side effects on every person I spoke to in hospital who took it. Even the anaesthatist admitted it was an unpleasant drug. If you can find a way to morphine-free pain relief, you will feel better, quicker.

OTHER PAIN RELIEF AND ANTI-INFLAMMATORY DRUGS
PARACETAMOL worked OK for me post-op and the intravenous drip is quick acting. DICLOFENAC (Voltarol) is an effective anti-inflammatory painkiller, but I found side effects of mood swings and bad tempers after taking them for more than a day. IBUPROFEN is what I chose to take along with Paracetamol as the main painkillers post op and for the first couple of weeks at home. Another drug recommended by a surgeon friend is NEFOPAM (Acupan) which provides strong pain relief with less side efects than Morphne, and it was specifically recommended as an alternative to Morphine immediately post-op. Don't be surpried if the nursing staff have not come across this though. Codeine and Co-codamol (Codeine/Paracetamol combination) are also commonly prescribed but I did not take them.

You've got to make your own choice on painkillers, but don't forget that you do have a choice and you can take control. Research these different painkillers on the web and understand their potential side effects. Don't be afraid to ask questions while you are in hospital.

ERRORS
It is possible that the hospital staff will make errors - this is what happened to me during 2 hip replacements"
- Epidural only worked on one side (unfortunately the wrong side)
- Epidural became disconnected behind my shoulder. No-one picked up on this despite me knowing that there was a problem - all they did was increase the dosage and no-one checked the connections for several hours
- I was given an opiate based drug when I specifically asked not to be given any
- I was given the wrong drugs on three separate occasions
This is simply to illustrate that you should be very aware of what constitutes your pain management and that you should play an active role in planning and executing it.

TIMESCALE
I took Paracetamol and Ibuprofen for about 3 weeks to 4 weeks post-op, gradually reducing the quantity and I found I needed no more painkillers after 4 weeks.

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