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A world leader in regional anesthesiology
and acute pain medicine for orthopedics

Safety & Side Effects

Blood Clot Risks

A blood clot can form when the blood vessel wall is damaged. This occurs when the rate of blood flow is diminished, or when there is an increased clotting tendency. The rate of blood clot formation varies depending on the type of surgery. Total hip and knee replacements have some of the highest rates of deep vein thrombosis of the leg.

While most of these blood clots do not cause symptoms, an estimated one in 100 patients having a joint replacement surgery will have a clot break off and travel through the heart to the lungs. This can affect circulation and respiration. Epidural anesthesia can reduce the risk of these complications. HSS anesthesiologists are experts in epidural anesthetic techniques.

Smoking, obesity, and estrogen all increase the risk of blood clot formation. You may want to discuss modifying these risk factors with your doctor before surgery. Be sure to tell your doctor if you've had a previous blood clot.

Postoperatively, you can promote blood flow and reduce your risk of blood clots by doing the exercises your physical therapist will prescribe you and walking with assistance as soon as possible. You may be given a medication to make the blood less coagulable and/or given a device that promotes blood flow.

Blood Supply Safety

There are many safeguards on our blood supply to ensure safe blood. First, blood is donated by volunteer donors. Before giving blood, donors must answer questions about their health and risk factors for disease.

Blood from each accepted donor goes through extensive testing. In addition to tests for blood type, nine separate screening tests are run for evidence of infection with hepatitis, HIV, HTLV, and syphilis. Then, the blood undergoes a process called crossmatch, where the blood sample is tested against blood from the patient who will receive it. Additional checks are then performed to compare the specific donor unit selected with the patient's blood.

If a blood transfusion is indicated during a surgical procedure or other medical treatment, the risks of not receiving blood far outweigh the risks of transfusion. Some patients may experience minor changes in the body's immune system after a transfusion, causing mild symptoms, such as fever, chills, or hives, which typically require little or no treatment. A small number of patients may also react to donated blood by developing antibodies (immune reactions).

The transmission of disease and the destruction of red blood cells occur only very rarely, and seldom threaten life. You do have choices other than receiving blood from the community blood supply. Autologous blood transfusion refers to procedures in which you may serve as your own blood donor. In preoperative autologous donation, your blood may be collected and stored before a scheduled surgery if blood use may be required. Please speak to your surgeon about autologous blood donations.

In intraoperative and postoperative autologous transfusions, blood lost during surgery is saved and returned to the patient.

Prescription Opioid Use

Opioid medications used to treat pain have many side effects ranging from nausea and vomiting to addiction. At HSS, we take your postoperative pain control seriously. While there is a need for opioid medications in some orthopedic cases, it is not the sole method of pain control your anesthesiologist and surgical team will rely on. Our anesthesiologists employ multimodal analgesia techniques to reduce the need for opiates.

These approaches to pain management include elevation of the body part, which can reduce pain and swelling, to acetaminophen and other anti-inflammatories. Sometimes, broad category anti-seizure medications and muscle relaxers are used in tandem with different methods to manage your pain.

Local anesthetics, which are frequently used by anesthesiologists at HSS, are another approach to acute pain management. Nerve blocks are injected before surgery and keep the body part numb anywhere from a few hours to a few days following surgery. Use of nerve blocks is associated with less pain after surgery which reduces the need for prescription opioids.

Patients with Prior Opioid Use
In some cases, patients undergoing surgery use opioids regularly and at a high level. It is important to share this information with your surgeon and anesthesiologist before surgery. We understand that many patients come to us in pain and may have been prescribed opioids by another physician, but in some cases, extended opioid use may interfere with your recovery. The Department of Anesthesiology, Critical Care & Pain Management provides individual counseling and care for patients with a history of opiate use.

Nausea & Vomiting After Surgery

Nausea and vomiting are commonly associated with anesthesia. While the reasons for these side effects are complicated, the risk of experiencing nausea and vomiting after surgery depends on the type of anesthesia, the procedure itself, and the medications used to treat postoperative pain.

Fortunately, your anesthesiologist has some medications to treat this problem, including using regional anesthetic techniques (when possible), administering anti-nausea medications before, during, and after surgery and providing treatment alternatives that reduce the need for additional medicines that are often associated with increased vomiting or nausea.

Female patients, those with a history of motion sickness, and patients with past experience of postoperative nausea and vomiting are at an increased risk of experiencing nausea and vomiting after surgery. If you have concerns, please tell your anesthesiologist before surgery, and he or she will customize an anesthetic plan to reduce the risk of nausea and vomiting after surgery.


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