Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

Abstract

Background and Aims:Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries.Material and Methods:A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal.Results:Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively.Conclusion:This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.

Incidence and Associated Factors of Postoperative Undesirable Anesthetic Outcomes Among Surgical Patients at Referral Hospitals in Amhara Region, Ethiopia: A Multi-Center Study

“…Postoperative back pain is frequently reported after RA. 35 It could be related to soft tissue damage during lumbar puncture. 36 …”

“…Postoperative back pain is frequently reported after RA. 35 It could be related to soft tissue damage during lumbar puncture. 36 Hunger is a complex process involving neuronal and systemic components.…”

Fears and perceptions associated with regional anesthesia: A study from a tertiary care hospital in South India

“…Resistance to RA may sometimes be observed among surgeons[ 8 22 ] in developing countries which is in contrast to the studies done in developed countries where the orthopedic surgeons direct their patients to choose RA. [ 5 ] If a patients’ surgeon is against RA, the anesthesiologist will not be able to persuade him/her about RA.…”

Preference of Elective Orthopedic Trauma Surgery Patients in Choice of Anesthesia Technique: A Prospective Cross-Sectional Study

“…Furthermore, some elder patients chose general anesthesia based on the recommendation of their surgeons (8). In a study conducted by Naik (17), it was demonstrated that younger patients are generally more knowledgeable about anesthesia than the older group of patients.…”

“…A survey that was conducted in 2002, concluded that the two main reasons that regional anesthesia is not favored by surgeons includes delay in operating rooms and unpredictable success rate (7). Surgeon's choice of anesthesiology method has a great impact on patient's choice (8). On the other hand, patient refusal to go through regional anesthesia is an absolute contraindication and one should never coerce patients to go through the procedure against their will.…”