The Practically Perfect Anesthetic for TKA

Photo by JoAnn Sturman

J. Greenawalt, M.D.

Dr. Greenawalt graduated from Oklahoma University College of Med 1983 and OU Anesthesia 1986. Practiced in Oklahoma City as a solo practitioner until Feb 1989. Moved to Tulsa and practiced at St Francis Hospital for 24 years. Our group did about 6,000 ultrasound guided blocks annually. Moved to Spokane, WA in July 2013 to be nearer mountains, clean water and nice summers.....

The perfect anesthetic (oxymoron but work with me here) for a total joint is:

Adductor hiatus block with 30 ml of 0.5% Bupivacaine.

Popliteal fossa approach to the sciatic nerve block with 20 ml of 0.125% Ropivacaine. (No foot drop with that technique and very few need anything the PACU except ear plugs for chatty patients.)

Spinal with no spinal narcotics. The spinal should be 0.5% isobaric Bupivacaine which will give you 3 hours but causes less sympathetic block than the hyperbaric Bupivacaine.

Propofol infusion, if the patient is anxious or not much if he is a Korean or WWII vet and did something in the war that you can chat about during the case.

1 gm TXA before the incision.

Post op Gabapentin and oral narcotics.

 Abu Simbel - photo by JoAnn Sturman