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.