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Evidence-based Practice and Quality Improvement

A survey of orthopedics patients who refuse regional anaesthesia, causes of refusal and the role of the anaesthesiologist

1AP3-11

Kiskira, O.; Papaioannou, A.; Kolotoura, A.; Vassilas, N.; Milioris, T.; Anastassiou, E.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 15-15
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Background and Goal of Study: Regional anesthesia (RA) for orthopedic surgery is a trend due to decreased nausea and vomiting, less postoperative pain and quicker mobilization. However, there are still orthopedic patients who refuse it. This study was carried out to investigate the reasons for refusing RA in order to gain some insights into the attitudes and concerns of patients and if there is the possibility of changing their opinion and choosing a safer type of anesthesia

Materials and Methods: After institutional approval, 100 patients who had refused regional anaesthesia during preanesthesia visit, were interviewed just before entering the operating room. They were asked to give one or two reasons for refusing regional anesthesia. After that, the anesthetist in charge tried to convince them for the benefits of RA versus GA by explaining the risks and underlying the quicker mobilization (p.es. early postoperative liquid and solid food consumption after a per. block.) After the operation pts were asked why they changed their mind and what type of anesthesia they would prefer for a future orthopedic surgery

Results and Discussion: 94 of the 100 pts were convinced to receive RA. 51 pts received neuraxial technique, 43 received PerNerve Block, 6 GA.

56% of the fears of the respondents were about paralysis and neurologic disorders, 38% about seeing the surgery and hearing the surgical procedure, 32% about peri-operative pain, 29% were worried of backache and 14% were afraid of the needle. None of the patients were aware of the risk of aspiration or the risks of general anaesthesia. Finally, 96.8% of the pts who received regional anaesthesia would choose regional anaesthesia for a future orthopedic surgery.

The most important reason for changing their minds was the reassurance that the complications are not so often as they thought, that they would receive a sedative and the early postoperative liquid and solid food consumption after a block

Conclusion: Patients' fears and conceptions about regional anaesthesia are distorted due to the lack of information regarding regional anaesthesia and the risks of general anaesthesia.

Anesthesiologists should be aware of the patients' concerns and must be capable and willing to discuss with them the relevant problems and suggest with evidencebased data the safest way to receive anesthesia.

© 2013 European Society of Anaesthesiology