General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satisfaction Levels: A Prospective Service Evaluation in the Oxford University Hospitals

Abstract

Introduction Lower limb arthroplasty is performed under general anaesthesia (GA) or regional anaesthesia (RA). There is increasing evidence of the surgical and anaesthetic benefits of RA. National Institute for Health and Care Excellence (NICE) guidelines advise using either but highlight a lack of data comparing outcomes of RA and GA for these procedures. We conducted a service evaluation, prospectively analysing elective orthopaedic cases performed at the Nuffield Orthopaedic Centre, Oxford, UK from 19/11/2018 to 03/04/2019. We aimed to compare data on anaesthetic assessment, intra-operative parameters and patient satisfaction for RA and GA cases. Methods We selected elective patients, aged above 18, undergoing total hip, total knee or unilateral knee arthroplasties. Prospective quantitative and qualitative data were collected using two forms. Firstly, anaesthetists completed a case report recording demographic data, intra-operative details and reason for anaesthetic choice. Secondly a questionnaire gathered patient satisfaction data. This was analysed using descriptive statistics and presented in tables. Results Data for 132 patients were collected over the service evaluation period. After exclusion, 99 patients were included for final analysis; 59 underwent GA and 40 had RA. GA was used predominantly due to patient preference (74.6%). RA was used primarily due to anaesthetic preference (75%); most commonly due to speed of list and duration of operation. Overall patients had low pain scores (0.3/10) and high pre-operative anxiety levels (4.6/10) regardless of anaesthetic. Conclusion Our results show high patient satisfaction with GA and RA for lower limb arthroplasty; however, pre-operative anxiety was common for both. Patient preference and comfort influenced choice of anaesthesia, highlighting the importance of pre-operative counselling and education to facilitate shared decision making, leading to favourable post-operative outcomes.

The Safety of Peripheral Nerve Blocks: The Role of Triple Monitoring in Regional Anaesthesia, a Comprehensive Review

“…There are specialties where all the procedures are performed under general anaesthesia (neurosurgery and cardiothoracic surgery), but, for example, in the case of orthopaedic procedures, especially of the extremities, the number of cases when regional anaesthesia is administered by far exceeds that of using general anaesthesia. The percentage of cases when regional anaesthesia is performed ranks particularly high in centres with extensive experience in this field and, thus, is characterized by high safety and high efficiency [5]. Thanks to regional anaesthesia techniques, general anaesthesia can be avoided in patients for whom the latter is associated with high risk.…”

Perioperative Ängste und die Angst vor dem Tod

“…Einerseits wird berichtet, dass v. a. Patienten mit höherer präoperativer Ängstlichkeit häufiger eine Allgemeinanästhesie für sich auswählen [ 43 ], andererseits zeigen Patienten, die sich für eine Regionalanästhesie entscheiden, höhere präoperative Cortisol- und Angstwerte als jene, die sich einer Allgemeinanästhesie unterziehen. Zudem finden sich auch Berichte, die keinen Unterschied und keine direkte Beziehung zwischen präoperativer Angst und Art der Narkose konstatieren [ 40 ]. Es lässt sich daher nur spekulieren, ob sehr ängstliche Patienten im Sinne psychischer Abwehr eher zu einer Allgemeinanästhesie neigen, während weniger ängstliche Menschen die Regionalanästhesie präferieren.…”

Regional versus general anesthesia for ambulatory total hip and knee arthroplasty

“…Indeed, patient satisfaction has become a major factor in perioperative care and medicine in general. While overall patient satisfaction is high for patients undergoing TJA under both SA and GA [27 ▪ ,28,29], there is evidence that SA patients may be more likely than GA patients to request a change in anesthesia type for a subsequent surgery [28,29]. Although the reasons for this are not clear, fear of SA was the main influencing factor for 30% of the patients who chose GA in one study of ambulatory surgical patients [30].…”