DAYCASE SHOULDER SURGERY INTERSCALENE BLOCK VERSUS GA. A PATIENT CHOICE & SATISFACTION SURVEY

Abstract

The literature shows that interscalene anaesthesia (ISA) offers many advantages over general anaesthesia(GA) for arthroscopic surgery. There are benefits intra-operatively, a decrease in post-operative complications and a decrease in hospital stay. However patient satisfaction and acceptance of interscalene anaesthesia has not been fully assessed. We wanted to prospectively assess patient choice and satisfaction with interscalene anaesthesia compared to general anesthesia.

Fifty patients undergoing subacromial arthroscopic decompression and suitable for either anaesthetic technique, were prospectively identified between August and December 2006. The anaesthetic team discussed the pros and cons of general anaesthesia versus interscalene anaesthesia and the patient choose the type of anaesthesia. The same anaesthetic team and senior author managed and operated on all the patients in the study. Post-operatively patients filled out a questionnaire, which assessed patient choice, experience and satisfaction with type of anaesthesia undertaken.

Forty-sic patients successfully completed the questionnaire (27 female, 19 male, average age 59). Seventy-six percent of patients felt that they really understood the pros and cons of each anaesthetic type. Seventy-eight percent of patients felt that they really had the choice in determining their anaesthesia. Twenty-six choose ISA and twenty choose GA. Post-operative complications were less in the ISA group versus the GA group; pain(5.23ISA, 5.75GA), nausea(11%ISA, 35%GA), vomiting(0 ISA, 1GA), and drowsiness(19% ISA, 70%GA). Hospital stay was shorter in ISA patients compared to GA patients. All patients claimed to be satisfied with their choice and none would in retrospect change it.

Patients who choose interscalene anaesthesia had less post-operative pain, nausea, vomiting, drowsiness and shorter hospital stays then those patients who choose general anaesthesia for their shoulder surgery. This is consistent with the literature. All patients claimed to be fully satisfied with their hospital experience irrespective of the type of anaesthesia undertaken and none would have chosen differently.