SURGICAL ATTITUDES AND PREFERENCES REGARDING CHOICE OF ANAESTHESIA AMONGST ORTHOPAEDIC SURGEONS
AbstractBackground: Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower side effects such as nausea, vomiting, postoperative pain and early mobilization. Despite of this, some orthopaedic patients refuse this modality. This study was conducted to interrogate the surgeons about their choice of anaesthesia in order to gain some insights into the concerns of surgeons and to change their minds and choose a safer mode of anaesthesia. The aim of the study was to assess the surgeons’ fears and their perception about regional anaesthesia. Methods: After institutional approval, thirty surgeons from three different tertiary care hospitals were interviewed. They were asked questions as per the questionnaire to choose choice of anaesthesia for their patients. Results: After regional anaesthesia, 27.6% of respondents were concerned about paralysis and neurological disorders, 34.5% about seeing and hearing whatever is happening in theatre, 17.2% about perioperative pain, 24.1% about backache and 24.1% about delayed discharge. The most important reason to change their mind was the reassurance that the complications are not as frequently as they thought their patient would receive after a block. Conclusion: Due to the lack of information on regional anaesthesia and the risks of general anaesthesia, orthopaedic surgeons' fears and conceptions about regional anaesthesia are distorted. Anaesthesiologists should be aware of the concerns of the surgeons as well as the patients and should be willing to discuss the concerns with them and suggest the safest way to receive anaesthesia with evidence-based data.Keywords: Regional anaesthesia; general anaesthesia; post-operative complications
Williams JG, Jones JR. Psychophysiological responses to anaesthesia and operation. JAMA 1968;203(6):415–7.
Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain 2003;105(3):415–23.
Kiecolt Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol 1998;53(11):1209–18.
Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anaesthesia in hip surgery. Clin Orthop Relat Res 2005;441:250–5.
Brull R, McCartney CJ, Chan VW, El-Bheiry H. Neurological complications after regional anaesthesia: contemporary estimates of risk. Anesth Analg 2007:104(4):965–74.
Todd MM, Brown DL. Regional anaesthesia and postoperative pain management. Long term benefits from short term intervention. Anesthesiology 1999;91(1):1–2.
Suresh S, Barcelona SL, Young MM, Selegma I, Heffnen CL, Cote CJ. Postoperative pain relief in children undergoing tympanomastoid surgery. Is regional block better than Opioids? Anesth Analg 2002;94(4):859–62.
Chung F, Ritchie F, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997;85(4):808–16.
Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anaesthesia and postoperative behavioral outcomes. Anesth Analg 1999;88(5):1042–7.
Yunus AA, Nwasor EO, Idris ME, Ejagwulu FS. Regional Analgesia for postoperative pain management-Initial experience in low resource setting. East Afr Med J 2012;89(3):100–5.
United States. Dept. of Health, United States. Public Health Service. Acute Pain Management: Operative Or Medical Procedures and Trauma. US Department of Health and Human Services, Public Health Service, Agency and Research, 1992; p.13–5.
Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 1. Br J Anaesth 2010;104(5):538–46.
Rukewe A, Fatiregun A. The Use of Regional Anaesthesia by Anesthesiologists in Nigeria. Anesth Analg 2009;110(1):243–4.
Agarwal A, Kishore K. Complications and controversies of regional anaesthesia: a review. Indian J Anaesth 2009;53(5):543–7.
Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative outcomes and type of anaesthesia in hip surgical patients: An evidence based review. World J Orthop 2014;5(3):336–43.
Schug SA, Pflugger E. Epidural anarsthesia and analgesia for surgery: is the going still strong? Curr Opin Anaesthesiol 2003;16(5):487–92.
Le May S, Hardy JF, Taillefer MC Dupuis G. Patient satisfaction with anaesthesia services. Can J Anaesth 2001;48(2):153–61.
Ironfield CM, Barrington MJ, Kluger R, Sites B. Are patients satisfied after peripheral nerve blockade? Results from an International Registry of Regional Anaesthesia. Reg Anesth Pain Med 2014;39(1):48–55.
Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, et al. A survey of orthopaedic surgeons' attitudes and knowledge regarding regional anaesthesia. Anesth Analg 2004;98(5):1486–90.
Stavrou G, Panidis S, Tsouskas J, Tsaousi G, Kotzampassi K. An audit of operating room time utilization in a Teaching Hospital: is there a place for improvement? ISRN Surg 2014;2014:431740.
Weinbroum AA, Ekstein P, Ezri T. Efficiency of the operating room suite. Am J Surg 2003;185(3):244–50.
Zafar SU, Khan FA, Khan M. Standardization of Anaesthesia Ready Time and reasons of delay in induction of anaesthesia. J Pak Med Assoc 2006;56(3):112–5.
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321(7275):1493–7.
Martin G, Lineberger CK, MacLeod DB, El-Moalem HE, Breslin DS, Hardman D, et al. A new teaching model for resident training in regional anaesthesia. Anesth Analg 2002;95(5):1423–7.
Smith MP, Sprung J, Zura A, Mascha E, Tetzlaff JE. A survey of exposure to regional anaesthesia in American anaesthesia residency training programs. Reg Anesth Pain Med 1999;24(1):11–6.
Kopacz DJ, Neal JM, Pollock JE. The regional anaesthesia “learning curve”: what is the minimum number of epidural and spinal blocks to reach consistency? Reg Anesth 1996;21(3):182–90.
Ganapathy S, McCartney CJ, Beattie WS, Chan VW. Best evidence in anesthetic practice: prevention: epidural anaesthesia and analgesia does not reduce 30-day all-cause mortality and major morbidity after abdominal surgery. Can J Anaesth 2003;50(2):143–6.
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84(1):6–10.
Gupta B, Agrawal P, D’souza N, Soni KD. Start time delays in operating room: Different perspectives. Saudi J Anaesth 2011;5(3):286–8.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.