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from Section 3 - Passing the Gas
Published online by Cambridge University Press: 09 June 2025
Anaesthesia for orthopaedic surgery encompasses a wide range of surgeries, from degenerative or inflammatory joint replacements (e.g. hip and knee), frailty fractures (e.g. hip fractures), to major trauma with multiple fractures. Spinal surgery very often includes anaesthetising for patients who will undergo surgery in the prone position. Frailty fractures represent a significant health burden, and these patients require early surgery with multidisciplinary (e.g. from orthogeriatricians ) input to ensure a successful outcome.
Many orthopaedic operations on the upper limbs can be successfully undertaken with regional nerve blockage. Or in the case of lower limb surgery, spinal or epidural anaesthesia are commonly used. These techniques may or may not be combined with a general anaesthetic.
For orthopaedic surgery, antibiotic prophylaxis is very often administered. Limb surgery may involve the use of tourniquets to exsanguinate the limb and keep blood out of the operative field. Following deflation of the tourniquet, patients may bleed significantly and suffer a metabolic insult from a build-up of carbon dioxide, lactate, potassium and hydrogen ions.
Where cement is used, occasionally severe reactions can occur, (bone cement implantation syndrome - BCIS) causing systemic hypotension, pulmonary hypertension, cardiac arrythmias and even death.
For lower limb surgery in particular, thromboprophylaxis is essential to reduce the risk of DVT and pulmonary embolism. In addition, fat embolism occurs occasionally after trauma or surgery involving the pelvis or long bones.
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