Study reports differences in the use of regional anesthesia techniques

Study reports differences in the use of regional anesthesia techniques

Women, minorities, and patients enrolled in Medicaid are less likely to receive regional anesthesia techniques that sustainably improve outcomes after surgery. This emerges from research results that will be presented at the ANESTHESIOLOGY® 2022 annual meeting.

The study of more than 56,000 patients is the first to report these differences in patients undergoing one of seven common surgeries, including shoulder and knee replacements. Regional anesthesia involves injecting medications that numb the lower half of the body (spinal anesthesia) and/or the nerve in the area where surgery is being performed (nerve block). In some cases, a catheter may be placed near the nerve and anesthetic medication may be given continuously for several days after surgery.

Research has shown that regional anesthesia significantly reduces pain after surgery, limits the use of opioids, and simultaneously reduces complications. The use of regional anesthesia techniques has allowed a growing number of patients to undergo surgery under sedation rather than general anesthesia, meaning they typically do not need to have a tube inserted down their throat to aid breathing.

We still have work to do when it comes to ensuring equitable anesthesia care for some of our most common surgeries. Several factors may contribute to this inequality. Certain patients may be less inclined to receive regional anesthesia because they are afraid of needles or do not understand their benefits. Or they may simply be offered the option of regional anesthesia less consistently due to practice trends in a particular hospital or surgical center or individual preferences of surgeons or anesthesiologists. This research provides the framework for further studies to understand why this is the case and to determine how access to this valuable care can be improved.”

Alex Beletsky, MD, lead author and resident anesthesiologist, Riverside Community Hospital, California

Researchers retrospectively reviewed the records of 56,881 people ages 18 and older who underwent surgery between January 2016 and June 2021. Surgeries included: knee replacement, shoulder replacement, carpal tunnel release, knee anterior cruciate ligament (ACL) reconstruction, ankle fracture repair, total abdominal hysterectomy, and creation of arteriovenous (AV) fistulas for dialysis.

The main results of the study showed the following:

• Bei Patienten mit Medicaid-Versicherung war die Wahrscheinlichkeit, eine Regionalanästhesie zu erhalten, um 39 % geringer als bei Patienten mit Privatversicherung.
• Bei Minderheitenpatienten (z. B. schwarzen und anderen nicht-weißen Patienten) war die Wahrscheinlichkeit, dass sie eine Regionalanästhesie erhielten, um 29 % geringer als bei weißen Patienten.
• Bei Patienten mit schwerwiegenderen Erkrankungen war die Wahrscheinlichkeit, dass sie eine Regionalanästhesie erhielten, um 12 % geringer als bei Patienten mit weniger schwerwiegenden Erkrankungen.
• Bei weiblichen Patienten war die Wahrscheinlichkeit, eine Regionalanästhesie zu erhalten, um 11 % geringer als bei männlichen Patienten.

“We are becoming increasingly aware of the various benefits of regional anesthesia techniques for surgical procedures, including improved postoperative pain, reduced postoperative opioid consumption, reduced nausea and vomiting, and higher same-day discharge rates,” said Dr. Beletsky. "Because these surgeries can be very painful, patients often appreciate these pain-relieving techniques. And because of their benefits, you can imagine how important it is for patients to be offered the opportunity to receive them."

Source:

American Society of Anesthesiologists

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