Capdevila X, Aveline C, Delaunay L et al
Advances in Therapy 2020 37:527-540
Aim of Study
To look at the factors determining the choice of anaesthesia for short duration procedures.
Design and Location
Observational, prospective, multi-center, cohort trial in France with data collection in 2015-2016
Methodology
Inclusion criteria were adults, day surgery, GA or spinal.
Exclusion criteria were emergency surgery, contra-indication to day case or spinal anaesthesia and participation in another trial in the 1 month preceding.
Questionnaire to look at medical status, type surgery, choice anaesthetic and post-operative factors such as ambulation, voiding, time to discharge eligibility plus patient satisfaction.
Primary Outcome
To determine the factors influencing choice of anaesthetic (spinal versus GA)
Secondary Outcomes
Efficacy of anaesthesia, time to hospital discharge, patient satisfaction.
Statistics
Satisfactory numbers achieved for statistical power. Mann-Whitney, Krustal-Wallis and student t test used.
Results
66.1% patients free to choose their type of anaesthetic, 21.8% chose one type as afraid of other, 16.8% based choice on ease of recovery, 19.2% considered degree of anxiety and stress. 16.9% chose technique based on its efficacy. Median time between start anaesthetic and knife to skin (15 mins for GA and 20mins for Spinal). Time to eligibility for discharge essentially the same (302.6mins for Spinal and 301.7mins for GA)
Conclusions/Discussions
Paper favours use of spinal anaesthesia with short-acting local anaesthetics. However, I feel difficult to draw this conclusion. It does highlight that patient choice (and informed choice) is important and that spinal with short acting local anaesthetics is a viable alternative to GA in day case surgery.
Stated Limitations from the Study
Vague methods and observational study so no randomisation. Patients and anaesthetists free to choose the type of anaesthesia with no standards for pre-operative discussions.
Discussion from Journal Club Meeting (?Change of Practice)
Difficult to draw valid conclusions from study due to vague methods. Particularly what questionnaires actually entailed and how anaesthesia was chosen. Data also difficult to interpret. Recovery times appear to be similar between spinal and GA suggesting that spinal is a viable alternative in day case. However, this is only with short acting local anaesthetics of which prilocaine is available in this Trust but unclear how widely used.
Summary by Dr A Dean. Journal Club Meeting 20th October 2022.
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