Patients in the United Kingdom are watching cricket matches while getting a new hip or knee, according to Judy Hobson, writing in the Daily Mail. Patients who are not likely to become upset by the sounds of hammering and sawing can opt for a spinal block that numbs sensation from the waist down for four to five hours instead of general anesthetic. Patients who make that choice are fully alert during the procedure.
Watching Cricket During Surgery?
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Jeannette Griffin, 68, was having her right hip replaced and wanted to follow her favorite cricket team on the radio. The anesthetist lent her his iPad so she could watch the game. “I could hear some hammering in the background but I was prepared for that. I was conscious my body was being pulled around slightly, but it didn’t disturb me and I had no pain whatsoever, ” she told Hobson.
The UK doctors have noted that patients who have a spinal block need less pain medication following the surgery and have a lower risk of a deep vein thrombosis. It is also a better option for patients with severe respiratory disease.
The anesthetist who cared for Griffin said, “’I see patients before surgery and reassure them that with a spinal block they won’t feel anything from the waist down. If they feel anxious, they can also be given intravenous sedation to relax them. And if surgery takes longer than expected a general anesthetic can still be used. A general would also be offered if someone undergoing hip surgery felt they couldn’t lie in one position—not moving their upper body—during the operation.”
With a spinal block, a needle is threaded through a gap between the bones in the lower back and the physician injects local anesthetic into the area to numb it. Having a spinal block when a patient is having a hip or knee replaced is becoming increasingly common in the UK, according to Elis Hughes, M.D., and a consultant anesthetist at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry.
He told Hobson, “In 2003, I anaesthetized 43 hip patients and only 6 had spinal blocks. This year I’ve done 42 so far and all of them had a block. The majority opted to stay fully awake throughout the procedure.”
Patients’ biggest concern is the noise—all the sawing, hammering and drilling—that goes on during the procedure, says Hughes. “Many of them bring in MP3 players so they can listen to their favorite music.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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