Enhanced Recovery Programme
My preferred regimen for hip replacements utilises what has been dubbed an ‘Enhanced Recovery Programme’. This involves a combination of techniques designed to minimise the post-operative ‘hangover’ and allows the patient to get up and out of bed the same day as surgery. This does not mean that you will be going home the same day, but it does allow early mobilisation, which reduces the risks of blood clots (DVT) and overall length of stay.
The type of anaesthetic we use is also part of this programme, and involves a ‘spinal’ with sedation. This is not a general anaesthetic where you are put to sleep and a tube passed into your throat to help you breathe. The ‘spinal’ is an anaesthetic technique, which involves an injection in your back, a little like an epidural that women sometimes have during childbirth. Once this has been done, which usually takes a couple of minutes, the anaesthetist will give a shot of sedation to drift you off into a light sleep. (You won’t usually need to be awake and have to listen to the operation being performed, or my chatting as I go!). You will have a standard oxygen mask placed over your nose and mouth, but will not need any tubes in your mouth, so no sore throat! Spinal anaesthesia is well recognised and a very safe way of ensuring that you don’t feel anything during the procedure.
During the procedure, I will inject the tissues around the hip with high volumes of Ropivicaine (a local anaesthetic) with adrenaline and sometimes ketorolac (an anti-inflammatory). The rationale for this is that the patient is far more comfortable after the operation and needs less opiate-type analgesia, which tends to make you feel sick and drowsy. Sometimes I will leave a small catheter in the joint to allow ‘top-ups’ of the local, but I am doing this less and less as evidence indicates the top-ups are less effective than the tissue infiltration. (I don’t use wound drains routinely).
When you wake up, you should be quite comfortable, and once the spinal anaesthetic has worn off and you can feel your legs again, the physios will get you out of bed so you can take your first steps on your new hip!