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Before surgery
Fasting and medicines work the same way as for any operation. Open each one to work it out here, without leaving the page.
Carbohydrate drinks
Some patients are given carbohydrate drinks, for example DEX, by their surgeon's rooms. They count as clear fluids. Follow the timing your surgeon's rooms give you. If you have diabetes or were given different instructions, follow those instead.
Before the day
You may be contacted by the pre-op nursing team or a perioperative physician. Dr Halvey may also contact you to talk through your plan.
The anaesthetic
Your anaesthetic is usually a combination of these parts. Your own plan is agreed with you before surgery.
| Part | What it involves |
|---|---|
| Spinal injection | A single injection in the lower back to numb your legs. This is standard, together with the general anaesthetic, so you are both numb and asleep. |
| General anaesthetic | You will be fully asleep during surgery. This is standard, alongside the spinal. |
| Sedation, if you prefer | Some patients would rather have the spinal with sedation than be fully asleep. This is possible if you want it; talk to Dr Halvey about it before the day. |
| Nerve block | Numbing medicine placed near the nerves to your leg, using ultrasound. Depending on your operation and your surgeon, this is either a single injection, or a soft plastic tube (catheter) that keeps the numbing medicine running through a small portable pump. |
Pain relief in hospital
Your nerve block keeps your leg numb at first. If you have a catheter, numbing medicine keeps running into your leg through the pump. Alongside this you take regular pain tablets. The Acute Pain Service team can adjust your medicines if you need it. Common medicines are paracetamol, celecoxib (Celebrex) for inflammation, and tapentadol (Palexia), taken regularly with extra doses when needed.
Pain relief at home
Most people find the knee comfortable at rest and sorer with movement, especially bending and physiotherapy. The aim is to keep you walking and doing everyday things. A typical plan looks like this. Always follow the prescription your team gives you.
| Time after surgery | What usually happens |
|---|---|
| Weeks 1 and 2 | Regular paracetamol and celecoxib. Slow-release tapentadol twice a day, with fast-release doses for extra pain, especially after physiotherapy. |
| Weeks 3 and 4 | Slow-release tapentadol is gradually reduced. Paracetamol and celecoxib continue. Fast-release doses only if needed. |
| Weeks 5 and 6 | Slow-release tapentadol at night only, then stopped. The aim is to stop all strong opioid medicines by week 6. |
| Week 7 onwards | Opioids stopped as soon as your pain allows. If pain is ongoing, see your GP or surgeon. |
Open your pain relief plan if you have a code from Dr Halvey.
Celecoxib after joint replacement
Using celecoxib (Celebrex) for a few weeks after your hip or knee replacement is a common part of pain management. In appropriately selected patients, it has been shown to be safe with a very low risk of serious side effects.
What the research shows
- Stomach and bowel (GI) bleeding: Very uncommon - well under 1% risk.
- Heart attack or stroke: Extremely rare - far less than 1% over 6 weeks in patients without existing heart disease.
- Kidney problems: Uncommon - around 1% or less, usually avoidable by staying well hydrated and keeping the course short.
- Wound healing and infection: Celecoxib does not appear to hinder healing or increase infection risk after surgery.
What this means for you
For most patients, a 6-week course of celecoxib:
- Provides effective pain relief.
- Reduces the need for stronger painkillers.
- Carries only a very small chance of serious complications (GI, heart, kidney, or wound-related).
Waterworks (passing urine)
- After surgery, numbness may make it difficult to feel when your bladder is full.
- This usually returns to normal within hours.
- Around 10% of patients have some difficulty passing urine at first.
- An ultrasound may be used to check your bladder. In some cases, a catheter may be needed temporarily.
Sleep
Sleep disturbance is common after knee replacement and may last for weeks. Adequate night-time pain relief is important, and problems may involve difficulty falling asleep or staying asleep. Options that may help include:
- Optimise your regular analgesia - keep taking paracetamol and any other pain killer medicines (if appropriate) so there are no gaps in pain relief overnight.
- For sleep initiation (falling asleep): Melatonin (immediate release) 1-3 mg taken 30-60 minutes before bed. This aligns your body clock but has little effect on night-time awakenings.
- For sleep maintenance (staying asleep): Pregabalin 25-50 mg at night. This dampens nerve-related pain, reduces nocturnal pain flares and increases slow-wave sleep. Use 25 mg in older adults (above age 75) or if there is kidney impairment. Clonidine 25-75 micrograms at night. This suppresses night-time sympathetic surges and can help if you wake with a racing heart or agitation. Start with 25 micrograms and increase only with medical supervision, watching for low blood pressure.
Discuss these options with your GP if sleep remains difficult. Treatment should target the underlying causes of disturbed sleep, such as poorly controlled pain and autonomic overactivity, rather than just circadian timing.
Anaesthetic risks
Anaesthesia is very safe, but like any medical procedure, risks can occur.
- Common (5-25%): Nausea, sore throat, dizziness, urinary difficulty, sleep disturbance.
- Uncommon (<5%): Severe pain immediately after surgery, confusion, hallucinations, dental injury, eye irritation, blood clots.
- Rare (<1%): Airway emergency, aspiration of stomach contents, severe allergic reaction, permanent nerve injury, infection or bleeding at block sites, heart attack or stroke, fat embolism.
Death directly related to anaesthesia is extremely rare (about 1 in 60,000).