General or spinal anaesthesia for my knee operation: which is safer?

The short verdict

There is no single right answer for everyone. For knee replacement, spinal anaesthesia is commonly used and may mean less nausea and grogginess afterwards, and good early pain relief. For shorter keyhole operations such as arthroscopy or ACL reconstruction, general anaesthesia is often used and wears off quickly. Many patients also have a nerve block around the knee to reduce pain after surgery, whichever main method is chosen.

How they compare

• What you experience: with a spinal you are numb from the waist down and can be lightly sedated so you doze; with general anaesthesia you are fully asleep
• Breathing: general anaesthesia usually needs a breathing tube or airway device; spinal does not
• After surgery: spinal often means less sickness and drowsiness, but your legs stay numb for a few hours; general anaesthesia may leave you groggy for a while
• Bladder: a spinal can temporarily make passing urine slower
• Side effects: spinal can cause a headache in a small number of people; general can cause sore throat and nausea
• Not suitable when: spinal may be avoided if you take certain blood thinners or have some spine problems; general may be less suitable with some lung conditions

Who each option tends to suit

Spinal anaesthesia tends to suit many people having knee replacement or other longer lower-limb surgery, older adults, and those with some heart or lung conditions. General anaesthesia tends to suit shorter arthroscopic operations, people who prefer to be fully asleep, those on blood thinners that cannot be stopped, and people with previous spinal surgery that makes a spinal difficult. If you are anxious about hearing the operation, sedation and headphones are often possible with a spinal.

When to discuss it in Doha

Raise anaesthesia at your surgical consultation and at the pre-operative assessment. Bring a full list of medicines, especially blood thinners and diabetes treatment, and mention any previous reactions. At Aman Hospital the anaesthetist meets you before surgery to examine you and agree the plan, and Dr. Gelber coordinates pain relief so that you can start walking and physiotherapy early.