MARCH 29, 2024
Originally published by our sister publication Anesthesiology News
PARIS—If the results of a United Kingdom–based qualitative study accurately represent attitudes in the United States, then it seems when patients think about outpatient orthopedic anesthesia, they automatically default to general anesthesia, not regional anesthesia.
Researchers said this finding may be because regional anesthesia is poorly understood by patients—a phenomenon that might be altered by more
Originally published by our sister publication Anesthesiology News
PARIS—If the results of a United Kingdom–based qualitative study accurately represent attitudes in the United States, then it seems when patients think about outpatient orthopedic anesthesia, they automatically default to general anesthesia, not regional anesthesia.
Researchers said this finding may be because regional anesthesia is poorly understood by patients—a phenomenon that might be altered by more comprehensive preoperative consultations.
“In the U.K., most people are culturally accustomed to being unconscious during surgery,” study investigator Nicolas Suarez, BM BCh, a consulting anesthetist at Oxford University Hospitals NHS Foundation Trust, in England, told Anesthesiology News. “But there’s no physiological or scientific reason why that should be the case, so it must be cultural. So, we wanted to determine the various drivers that make people expect to be asleep during these day procedures.”
The investigators performed semistructured postoperative interviews with 19 patients (12 female, seven male) undergoing outpatient orthopedic surgery, which were then analyzed using thematic analysis.
“With thematic analysis, we analyzed every bit of text and the meanings attached to that bit of text,” Suarez said. “Then we grouped them together to see what themes arose out of that process.”
As Suarez reported at the 6th annual World Congress on Regional Anaesthesia and Pain Medicine, two superordinate themes were identified: the generation of anesthetic preferences and optimizing the preoperative anesthetic discussion. With respect to the first, it became apparent to the researchers that patients had strong preconceptions about the efficacy and appropriateness of general anesthesia. These beliefs, along with patients’ presurgical online research to inform the decision-making process, combined to bias the participants against regional anesthesia.
“People simply expected general anesthesia to be the anesthesia they would be undergoing,” Suarez explained. “It’s just considered the default. In addition, the participants were also quite squeamish about what they thought they might see, hear or smell if they underwent a procedure while fully awake.”
In terms of optimizing preoperative anesthetic discussions, the study found that although such consultations were felt to build rapport and increase patient satisfaction with care, this was not always the case. Indeed, rushed and pressured conversations served as barriers to the uptake of regional anesthesia, thereby risking patient disengagement. Perhaps not surprisingly, developing a rapport with the anesthesiologist before the day of surgery also facilitated patients’ willingness to undergo awake surgery.
“It’s normal practice in the U.K. for the anesthesiologists to meet the patient for the first time on the morning of surgery, and our participants said that’s too late to be making a big decision about the type of anesthesia,” Suarez noted.
Other findings of the study were grouped three ways:
In light of these results, the investigators said choice of anesthetic in outpatient orthopedic surgery is highly personal and affected by many factors.
“I think the broad conclusion would be that in our population, general anesthesia is considered the default,” Suarez said. “If you want to avoid that, you have to expend the effort to explain regional anesthesia to your patient.
“Most people think that general anesthesia is a low risk, and it seems that regional anesthesia is poorly understood,” he added. “Finally, I think the perceived risks of regional anesthesia, particularly spinal and epidural anesthesia, are overinflated.”
Garrett Barry, MD, commented that although introducing the option of regional anesthesia a few minutes before surgery is not ideal, it is often a reality for patients.
“Patient sentiments identified in this study are very understandable—when there is a lack of advance discussion, reliable education and feeling ‘pushed’ into an anesthetic choice they didn’t have enough time to think about,” said Barry, a staff anesthesiologist with the Vancouver Island Health Authority, in British Columbia. “This study supports the need for solidifying standards of anesthetic care, including regional anesthesia when appropriate, that the entire perioperative care team agrees upon and can talk to their patients about far in advance of surgery.”
By Michael Vlessides
Barry and Suarez reported no relevant financial disclosures.
