Updated December 08, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
While most people are anticipating some discomfort after joint replacement surgery, no one is prepared for pain during surgery. There are several options for anesthesia during a joint replacement, including general anesthesia and regional anesthetics.Â
Being Awake During Surgery
Some patients choose to stay awake during surgery. Typically, a surgeon will use a spinal or epidural anesthetic to numb the legs, and allow your surgeon to perform the operation.
 It is also common to use medications that cause general relaxation and amnesia (forgetfulness) during the operation. So while you may be breathing on your own, you may have your eyes closed and not remember the entire operation.
Depending on an individual patient's level of comfort and anxiety, some patients with regional anesthesia (spinal or epidural anesthesia) do choose to remain more alert during their procedure. While they may hear things (people talking, use of instruments including saws and drills), they will have no sensations of pain.
There are certain situations where one specific type of anesthesia is recommended over another. For example, people who have pulmonary issues may have a regional anesthesia recommended, whereas individuals with heart valve issues may be advised to have a general anesthetic.Â
Awareness During General Anesthesia
Awareness during anesthesia is a subject of recent concern. This is a complication of general anesthesia that occurs in a very small number of patients (around 1/10,000).
 Most often when a patient remembers something (noises, faces of doctors) during surgery it is because they had a regional anesthesia with some mild sedation, not that they woke up during a general anesthesia.
However, there are rare events when individuals have a complication called awareness during general anesthesia. The condition people fear is where they wake up, and are unable to move, yet still able to feel pain. This can occur if the anesthesiologist has administered a drug to paralyze the body without giving adequate medication to have you sedated. Almost always this occurs at the beginning of a surgery (before the operation has started), because that is the most common time for an anesthesiologist to administer paralyzing medications.Â
The possibility of awareness during general anesthesia causes significant concern for many patients. Fortunately, for patients undergoing elective surgery, including joint replacement surgery, the condition is very rare. Most commonly, awareness during general anesthesia occurs during emergency surgery, or in surgical procedures where the amount of anesthesia given to a patient must be limited. Patients who have awareness during general anesthesia often require emotional support and counseling, and post-traumatic stress disorder is common.
What Type of Anesthesia is Best?
You should discuss with your anesthesiologist all of your concerns about anesthesia, including awareness during surgery. As mentioned before, there are some situations where a particular type of anesthesia is preferred because of other medical conditions the patient has. In addition, there has been some recent data to support the use of regional anesthesia for patients having joint replacement surgery. In these patients, when regional anesthesia is compared to general anesthesia, patients having the regional anesthesia have been shown to have:
- Less blood loss
- Fewer complications
- Lower infection rate
As said before, every patient must be evaluated individually, and these are some of the issues you can discuss with your anesthesiologist when deciding which anesthetic is best.
Sources:
"Regional anesthesia technique significantly improves outcomes of hip and knee replacement" Hospital for Special Surgery. May 1, 2013.
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