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Frequently Asked Questions

Please visit this section if you have any questions you would like to ask of the editors, who are all renowned world experts in their fields, or if you just want to see the questions other patients frequently ask, and, of course, the answers by our experts to these questions.

Total Hip Arthroplasty

How long may I expect to stay in the hospital?

Depending on the general state of your health, you may be able to go home on the day of your surgery if your pain is well managed. If you have other medical issues, your health and safety will likely best best served by an overnight stay in the hospital. Most of the total hip arthroplasty patients are able to go home the morning after surgery. The APS team will ensure that your pain control is optimum. The Surgical and PT/OT teams will ensure that your post-surgical status is appropriate and that your mobility allows you to meet your personal care needs at home, with the assistance of your family. If the block you have is providing proper and manageable pain control, you may choose to be discharged with it in place.

How will my operating room care be accomplished?

Before the placement of the appropriate nerve block for postoperative pain control, the intraoperative anesthetic care will be discussed with you. The APS team and your surgeon recommend, where feasible, a spinal anesthetic, for your operative procedure. In certain medical considerations, a general anesthetic may be in your best interest. .

How will the nerve block be cared for when I go home?

Before you are discharged, the APS team will see you. Specific instructions will be provided and you will receive a battery-operated infusion pump containing 400 mL of 0.2% ropivacaine. The setting will be reviewed with you and your family. You will be given a number that you can call anytime. A representative from the APS will call you every day while the pain pump is infusing. When it is empty or has been off for 2 hours, please call the number provided. Your family member will be guided in a step-by-step manner to accomplish the removal of the perineural catheter.

I am being treated for chronic pain. How will this affect my care?

Anyone that is prescribed medication for chronic pain should, with the knowledge of his/her surgeon and APS physician, continue these medications the morning of surgery. The surgical team will continue your established treatment during and after your discharge. It is important that you stipulate during your pre-anesthetic evaluation what medication(s) you take for chronic pain. Continuing your established regimen, the use of the nerve block, and multi-modal therapy produces well-tolerated pain management in cases such as yours.

May I CHOOSE a general anesthetic?

You may choose a general anesthetic (GA). GA is perfectly reasonable and safe for your hip operation. It does require the administration of medication that produces unconsciousness and complete muscle relaxation. In addition, an “airway device” is inserted after you fall asleep. This device is removed before you awaken. GA is quite safe and is widely used. If you have had back surgery or problems, the APS or OR teams may suggest GA. Multiple medical conditions or extremes in body habitus at times necessitate GA. These are issue-specific conversations that may be had prior to your block procedure.

May I go home the day of surgery?

Some patients may elect to go home on the day of surgery. Those that choose this option coordinate this early in the preoperative stages with their surgeon’s office. The APS is made aware, as are the PT/OT staff, and the appropriate home health agencies. If mobility goals are met and your pain is manageable, you may be discharged home.

What if I am allergic to one of these medications?

In the case of an allergy, the medication will be eliminated from your regimen.

What if there is a problem with removal of the perineural catheter?

The APS at UF has placed literally thousands of these devices successfully. We currently place about 6500 perineural catheters per year. The incidence of difficulty with removal is extremely low. We send you home with this device with great confidence that the removal will be uneventful. In the highly unlikely occurrence of difficulty, you may be asked to return to the block room. We then may visualize the catheter and adjacent structures under ultrasound to aid in its removal.

What if there is a problem with removal of the perineural catheter?

What is “multi-modal” pain therapy? This is an approach whereby the pain generators that produce the inflammatory response are addressed. Specifically, Decadron (a steroid) and ketoralac decrease or limit the body’s response to the surgical procedure by decreasing the production of chemicals produced internally. In addition to initiating the healing process, these chemical are pain mediators. The medications reduce the release of this “chemical process” without interfering with healing, thus lessening the pain response.

What is a spinal anesthetic?

A spinal anesthetic consists of placing a small dose (2 mL) of bupivacaine into the subarachnoid space (spinal canal). This is done in the operating room after proper sedation and positioning. The skin over your lower back will be numbed prior to this procedure. A small needle (24-gauge) is placed through the skin between the lower lumbar vertebrae into the spinal canal. Once reached, 2 mL of bupivacaine is instilled though the needle. The needle is then removed. You may notice a warm sensation in your hips and thighs. You will be placed supine, sedation through the vein will begin, and then you will be placed with your operative hip in the “up” position. The OR anesthetic team, nursing team, and surgeon will ensure your comfort and safety throughout this process.

What is the biggest risk I face after my hip replacement?

There are many and myriad of potential difficulties to be considered. However, the greatest risk you face and the easiest to avoid is a FALL. In the hospital and at home, you must comply with the mobility and ambulation instructions prescribed by your surgeon and the PT/OT team. Adherence to these instructions and compliance with prescribed medication is extremely vital to your safe and successful recovery and rehabilitation.

What is the biggest risk I face after my hip replacement?

There are many and myriad of potential difficulties to be considered. However, the greatest risk you face and the easiest to avoid is a FALL. In the hospital and at home, you must comply with the mobility and ambulation instructions prescribed by your surgeon and the PT/OT team. Adherence to these instructions and compliance with prescribed medication is extremely vital to your safe and successful recovery and rehabilitation.

What type of pain control may I expect after my surgery?

Your surgeon will refer you to the Acute and Perioperative Pain Medicine Division at UF (APS). You will be offered a continuous nerve block. This will be placed in the Block Procedure Area, under proper sedation, prior to your operation. During the operation, in addition to your anesthetic, you will be given IV acetaminophen, IV Decadron, and IV ketorolac as the initiation of “multi-modal” therapy for postoperative pain management. These medications will be continued, by mouth, into your postoperative recovery.

Where will I go after the surgical procedure?

When the surgical procedure is completed, you will go to the Post-Anesthesia Care Unit (PACU) where you will awaken and recover from the anesthetic effects. When appropriate, your family may come to your bedside. The APS will visit at your bedside if your block needs to be evaluated. You will have an x-ray to verify the stability of your new hip. Physical and occupational therapy (PT/OT) will visit in the PACU. If you have had a spinal anesthetic, your sensation will gradually return. When your motor strength is judged appropriate, you may be assisted to ambulate at that time. If you have chosen to go home on the day of your procedure, PT/OT and the APS team will ensure you that have met mobility and pain control goals.

Why is a spinal anesthetic preferred?

A spinal anesthetic provides a very stable anesthetic course. While intravenous sedation is provided, major anesthetic drugs that produce unconsciousness are not needed. Years of experience and documentation in the surgical and anesthetic literature show that intraoperative blood loss occurs is less during arthroplasty performed under spinal anesthesia. With proper sedation and care in positioning, the patient experience is pain free and recall of intraoperative events is quite limited.

Why use a nerve block AND medicines IV and by mouth?

The nerve block is placed and dosed well before beginning the surgical procedure, thus interrupting nerve ”signals” from the surgical site BEFORE they occur. The IV and oral medications work together with the nerve block to lessen the body’s inflammatory/pain response. A lower overall dose of “numbing drugs” and oral medications may be used.

Will my pain control be adequate when the pain catheter is removed?

A perineural catheter that has been infusing for 3 to 4 days allows the body to recover to a point where the major inflammatory processes and pain responses have been greatly reduced. Continuing beyond 4 days (1 hospital day and 3 home days) with the perineural catheter is rarely considered. The oral regimen prescribed by your surgeon provides continued relief from discomfort during the recovery and rehabilitation process.

Will my pain control be adequate when the pain catheter is removed?

Will narcotic drugs be a part of my pain treatment? The sedation during the block procedure is a potent yet short-acting narcotic to ensure that you are comfortable during this process. During the operation, narcotics are a very small part (if any) of your anesthetic. Postoperatively, a “less potent” narcotic, Tramadol, will be used as a part of the multi-modal regimen. Oxycodone is reserved for breakthrough pain. IV narcotics are used sparingly and as a last resort after bedside evaluation by an APS physician and perhaps an orthopaedic surgeon. Your surgeon will discharge you with a short-term prescription for the narcotic of his/her choice.

Total Knee Arthroplasty

How long may I expect to stay in the hospital?

Depending on the general state of your health, you may be able to go home on the day of your surgery if your pain is well managed. If you have other medical issues, your health and safety will likely best best served by an overnight stay in the hospital. Most of the total hip arthroplasty patients are able to go home the morning after surgery. The APS team will ensure that your pain control is optimum. The surgical and PT/OT teams will ensure that your post-surgical status is appropriate and that your mobility allows you to meet your personal care needs at home, with the assistance of your family. If the block you have is providing proper and manageable pain control, you may choose to be discharged with it in place. .

How will the nerve block be cared for when I go home?

Before you are discharged, the APS team will see you. Specific instructions will be provided and you will receive a battery-operated infusion pump containing 400 mL of 0.2% ropivacaine. The setting will be reviewed with you and your family. You will be given a number that you can call anytime. A representative from the APS will call you every day while the pain pump is infusing. When it is empty or has been off for 2 hours, please call the number provided. Your family member will be guided in a step-by-step manner to accomplish the removal of the perineural catheter.

May I CHOOSE a general anesthetic?

You may choose a general anesthetic (GA). GA is perfectly reasonable and safe for your knee operation. It does require the administration of medication that produces unconsciousness and complete muscle relaxation. In addition, an “airway device” is inserted after you fall asleep. This device is removed before you awaken. GA is quite safe and is widely used. If you have had back surgery or problems, the APS or OR teams may suggest GA. Multiple medical conditions or extremes in body habitus at times necessitate GA. These are issue-specific conversations that may be had prior to your block procedure.

What if I am allergic to one of these medications?

In the case of an allergy, the medication will be eliminated from your regimen.

What is “multi-modal” pain therapy?

This is an approach whereby the pain generators that produce the inflammatory response are addressed. Specifically, Decadron (a steroid) and ketoralac decrease or limit the body’s response to the surgical procedure by decreasing the production of chemicals produced internally. In addition to initiating the healing process, these chemical are pain mediators. The medications reduce the release of this “chemical process” without interfering with healing, thus lessening the pain response.

What is a spinal anesthetic?

A spinal anesthetic consists of placing a small dose (2 ml) of bupivacaine into the subarachnoid space (spinal canal). This is done in the operating room after proper sedation and positioning. The skin over your lower back will be numbed prior to this procedure. A small needle (24-gauge) is placed through the skin between the lower lumbar vertebrae into the spinal canal. Once reached, 2 mL of bupivacaine is instilled though the needle. The needle is then removed. You may notice a warm sensation in your hips and thighs. You will be placed supine and sedation through the vein will begin. The OR anesthetic team, nursing team, and your surgeon will assure your comfort and safety throughout this process.

What is a spinal anesthetic?

What type of pain control may I expect after my surgery? Your surgeon will refer you to the Acute and Perioperative Pain Medicine Division at UF (APS). You will be offered a continuous nerve block. This will be placed in the Block Procedure Area, under proper sedation, prior to your operation. During the operation, in addition to your anesthetic, you will be given IV acetaminophen, IV Decadron, and IV ketorolac as the initiation of “multi-modal” therapy for postoperative pain management. These medications will be continued, by mouth, into your postoperative recovery.

What is a spinal anesthetic?

Where will I go after the surgical procedure? When the surgical procedure is completed, you will go to the Post-Anesthesia Care Unit (PACU) where you will recover from the anesthetic effects. When appropriate, your family may come to your bedside. The APS will visit you at the bedside if your block needs to be evaluated. Physical and occupational therapy (PT/OT) will visit you in the PACU. If you have had a spinal anesthetic, your sensation will gradually return. When your motor strength is judged appropriate, you may be assisted to ambulate at that time. If you have chosen to go home on the day of your procedure, PT/OT and the APS will ensure that you have met mobility and pain control goals.

Why is a spinal anesthetic preferred?

A spinal anesthetic provides a very stable anesthetic course. While intravenous sedation is provided, major anesthetic drugs that produce unconsciousness are not needed. Years of experience and documentation in the surgical and anesthetic literature show that intraoperative blood loss occurs less during arthroplasty performed under spinal anesthesia. With proper sedation and care in positioning, the patient experience is pain free and recall of intraoperative events is quite limited.

Why use a nerve block AND medicines IV and by mouth?

The nerve block is placed and dosed well before beginning the surgical procedure, thus interrupting nerve “signals” from the surgical site BEFORE they occur. The IV and oral medications work together with the nerve block to lessen the body’s inflammatory/pain response. A lower overall dose of “numbing drugs” and oral medications may be used.

Will narcotic drugs be a part of my pain treatment?

The sedation during the block procedure is a potent yet short-acting narcotic to ensure that you are comfortable during this process. During the operation, narcotics are a very small part (if any) of your anesthetic. Postoperatively, a “less potent” narcotic, Tramadol, will be used as a part of the “multi-modal” regimen. Oxycodone is reserved for breakthrough pain. IV narcotics are used sparingly and as a last resort after bedside evaluation by an APS physician and perhaps an orthopaedic surgeon. Your surgeon will discharge you with a short-term prescription for the narcotic of his/her choice.

Total Shoulder Arthroplasty

Are there any special considerations at discharge?

When discharged from the hospital, if you go home with a continuous infusion pain control device, you must be accompanied by someone who will be with you for the first 3 days after your surgery. You may not go home alone.

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How will my operating room care be accomplished?

For a Total Shoulder Arthroplasty, a general anesthetic is the best plan and technique. The draping and positioning process will render you immobile and the sterile drapes will cover your face. You must remain in this position throughout the procedure. Even with a surgical-quality nerve block, your intraoperative comfort during a regional-only technique would not be in your best interest. The presence of the nerve block enables your anesthetic team to provide a “lighter” general anesthetic.

How will the nerve block be cared for when I go home?

Before you are discharged, the APS team will see you, give you specific instructions, and connect a battery-operated infusion pump containing 400 mL of 0.2% ropivacaine. The setting will be reviewed with you and your family. You will be given a number that you can call anytime. A representative from the APS will call you every day while the pain pump is infusing. When it is empty or has been off for 2 hours, please call the number provided. Your family member will be guided in a step-by-step manner to accomplish the removal of the perineural catheter.

What if I am allergic to one of these medications?

In the case of an allergy, the medication will be eliminated from your regimen.

What if there is a problem with removal of the perineural catheter?

The APS at UF has placed literally thousands of these devices successfully. We currently place about 6500 perineural catheters per year. The incidence of difficulty with removal is extremely low. We send you home with this device with great confidence that the removal will be uneventful. In the highly unlikely occurrence of difficulty, you may be asked to return to the block room. We may then visualize the catheter and adjacent structures under ultrasound to aid in its removal.

What is “multi-modal” pain therapy?

This is an approach whereby the pain generators that produce the inflammatory response are addressed. Specifically, Decadron (a steroid) and ketoralac decrease or limit the body’s response to the surgical procedure by decreasing the production of chemicals produced internally. In addition to initiating the healing process, these chemical are pain mediators. The medications reduce the release of this “chemical process” without interfering with healing, thus lessening the pain response.

What is the aftercare for a perineural catheter?

Once the infusion is complete or has been discontinued for 2 hours AND your motor and sensory function has returned, you may call the APS for removal guidance. Once the device is removed, the area may be cleaned with alcohol to remove any residual adhesive. A clean, dry band-aid may be placed over the site.

What type of pain control may I expect after my surgery?

Your surgeon will refer you to the Acute and Perioperative Pain Medicine Division at UF (APS). You will be offered a continuous nerve block. This will be placed in the Block Procedure Area, under proper sedation, prior to your operation. During the operation, in addition to your anesthetic, you will be given, IV acetaminophen, IV Decadron, and IV ketorolac as the initiation of “multi-modal” therapy for postoperative pain management. These medications will be continued, by mouth, into your postoperative recovery.

What type of pain control may I expect after my surgery?

When will I be able to return home? Depending on the general state of your health, you may be able to go home on the day of your surgery if your pain is well managed. If you have other medical issues, your health and safety will likely best best served by an overnight stay in the hospital. Most of the total shoulder arthroplasty patients are able to go home the morning after surgery. The APS team will ensure that your pain control is optimum. The surgical and physical and occupational therapy (PT/OT) teams will ensure that your post-surgical status is appropriate and that your mobility allows you to meet your personal care needs at home, with the assistance of your family.

Where will I go after the surgical procedure?

When the surgical procedure is completed, you will go the the Post-Anesthesia Care Unit (PACU) where you will awaken and recover from the anesthetic effects. When appropriate, your family may come to your bedside.

Why use a Nerve Block AND medicines IV and by mouth?

The nerve block is placed and dosed well before beginning the surgical procedure, thus interrupting nerve “signals” from the surgical site BEFORE they occur. The IV and oral medications work together with the nerve block to lessen the body’s inflammatory/pain response. A lower overall dose of “numbing drugs” and oral medications may be used.

Will narcotic drugs be a part of my pain treatment?

The sedation during the block procedure is a potent yet short-acting narcotic to ensure that you are comfortable during this process. During the operation, narcotics are a very small part (if any) of your anesthetic. Postoperatively, a “less potent” narcotic, Tramadol, will be used as a part of the “multi-modal” regimen. Oxycodone is reserved for breakthrough pain. IV narcotics are used sparingly and as a last resort after bedside evaluation by an APS physician and perhaps an orthopaedic surgeon. Your surgeon will discharge you with a short-term prescription for the narcotic of his/her choice.

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