Patient's perspectives of regional Anaesthesia at the KNH following Elective Orthopaedic surgery
Abstract
The use regional anaesthesia (RA) is on the increase world over. At
the Kenyatta National Hospital (KNH), the use of RA is on the
increase as well. Much advocacy for RA stems from a better
safety profile in comporison to general anaesthesia among other
advantages such as the prevention of chronic pain. RA is
undoubtedly cheaper. Diverse arguments have been forwarded
in respect to surgical outcome.
The practice of RA at the KNH is varied in its application and the
choice of patients stemming from the wide range of anaesthesia
practitioners and KNH being a teaching hospital as well. Thisstudy
is aimed at getting the patients perspectives of RA practice in the
KNH orthopaedic surgeries. Thisposes a unique challenge to the
patient and the anaesthetist given the poor penetration of RA in
the country as a whole, since many patients are accustomed to
general anaesthesia. There is no data locally on RA outcomes with
regards to patient satisfaction.
With KNH/UoN Research ethics approval and patient consent, this
cross-sectional study was carried out over a two month period on
97 patients after elective orthopaedic surgery at the KNH
orthopaedic elective theatres. The patients were recruited after
surgery and the questioner administered by the investigator.
Statistical Package for Social Sciences (SPSS)was used to analyse
the data.
In this study, 97 patients were recruited with a median age of 34
years, 73.2% being males and 26.8% females, 28.9% having had
previous surgery. The most commonly used RA technique was
neural-axis block, 70.1%. Pre-operative review stood at 69.1%, with
the content of the reviews being variable, with explanations of
anaesthesia modality explained to 65.7% of the patients and
advantages and disadvantages explained to 30.9%. Intra-
8
operatively, 17%of the patients said they experienced pain at the
beginning of the operation. 16%chose to be sedated and those
sedated was 42%,with 21%updated on the progress of surgery.
Post-operatively, 17.5%of the patients got an explanation on
recovery, one patient had pain immediately post operatively.
111.3%of the patients were reviewed by the patient postoperatively.
75%of the patients said they would opt for RAfor
future surgeries if applicable.
From this study, it was concluded that majority of the RApractice
isneural axis block, with the knowledge of RAamong patients
being very low. The practice is not standard with very variable
patient involvement. Pain control isadequate with RA.Despite the
lack of optimal RApractice, majority of the patients would prefer
RAto GA for repeat operations.
It isrecommended that a RAprotocol be developed and
inculcated into the training programs at the KNHand training
institutions allied to KNH.There should also be an increase in
patient involvement.
Citation
M.Med, AnaesthesiaPublisher
University Of Nairobi College of Health Sciences