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• W2004062979 abstract "EDITOR: A recent French survey showed that the techniques of anaesthesia have changed dramatically since the beginning of the 1980s [1]. This is particularly true for regional anaesthesia (RA) the use of which has increased from 4% of the 3 600 000 anaesthetic procedures in 1980, to 23% of the 7 937 000 procedures in 1996. For several specific operations, the decision to undertake general anaesthesia (GA) instead of RA is easy or has proven advantages. However, in many circumstances this decision is questionable because neither technique has definite and proven advantages. The aim of this study was to determine which factors lead to the use of RA (rather than GA) in several specific surgical procedures where both anaesthetic techniques can be easily used. Material and methods describing this national survey have been recently published [1]. For this secondary analysis, seven surgical procedures were selected since they can be performed under either GA or RA (inguinal herniorraphy, repair of femoral neck fracture, hallux valgus surgery, varicose vein surgery, knee arthroscopy, carpal tunnel release and total hip replacement). RA was thus defined as RA only or with combined sedation. Independent variables describing the characteristics of patients were gender, age (yr) and American Society of Anaesthesiologists Grades (ASA I-II vs. ASA III-V). Each anaesthesia was characterized by several variables: elective (yes/no), emergency (yes/no), ambulatory condition (yes/no) and duration (min). The type of hospital was categorized into three classes: teaching hospitals, community hospitals and private centres. The presence of a postoperative pain service was unknown from the data available. Univariate analysis followed by multivariate analysis (logistic regression) was performed and adjusted odds ratio (AOR) was calculated and Wald tests computed (P = 0.05). The frequency of RA use varied markedly according to the type of surgery: inguinal herniorraphy (25%), knee arthroscopy (33%), varicose vein surgery (34%), total hip replacement (34%), hallux valgus surgery (50%), repair of femoral neck fracture (54%), carpal tunnel release (77%). RA was more frequently used for males (35% vs. 27% for arthroscopy and 27% vs. 18% for inguinal hernia surgery). There was a significant association between increasing age and RA for all types of surgery studied (Fig. 1). A high ASA score (ASA > II) was significantly associated with RA for total hip replacement and inguinal hernia surgery. Long duration of anaesthesia was associated with RA for most procedures but a shorter duration was associated with an increased use of RA for total hip replacement. Ambulatory surgery was associated with an increased use of RA for carpal tunnel release. For most procedures, teaching hospitals performed less RA than community hospitals or private centres.Figure 1: Use of RA according to patient's age and type of surgery. ━●━: total hip replacement (THR); SYMBOL: hallux valgus (HV); ―▲―: fracture of femoral neck (FFN); ·····●·····: knee arthroscopy (KA); ―◆―: inguinal hernia (IH).SymbolMultivariate analysis showed that except for carpal tunnel release, age remained a factor associated with increased RA use. The AOR for the upper quartile of age ranged between 1.6 (varicose vein surgery) and 7.8 (hallux valgus surgery). An association with ASA Grade was not observed in either situation. A long duration of anaesthesia was associated with use of RA with AOR for the upper quartile ranging from 3.8 (varicose vein surgery) to 11.3 (carpal tunnel release). By contrast, for total hip replacement, long duration was associated with use of GA. The male gender and surgery performed in a private centre were associated with increased use of RA but the odds ratio was <2 for most procedures. The main finding of this study was that, in France, use of RA for non-obstetric surgery is mainly related to increased patient age. Although RA is often felt safer by both patients [2] and physicians [3], the beneficial effects of RA on postoperative outcomes remain controversial and may not explain the increased use of regional techniques in older patients. Increased use may thus only be related to better acceptance of these techniques in this population. Increased ASA score was not associated with an increased rate of RA and was probably largely masked by the powerful effect of increased age. A (predicted) long duration of surgery was found in some surgical models to relate to an increased use of RA. However, in other models the relation was the opposite. Surgeons' acceptance of an awake patient under RA is often more difficult to obtain when a long operation is awaited and prolonged surgery may also increase patients' anxiety. Finally, their immobility for several hours is an almost impossible objective to reach. We found that ambulatory patients undergoing carpal tunnel release received RA more frequently than hospitalized patients. The perceived advantages of RA techniques relate to increased alertness, decreased postoperative pain and nausea, more rapid discharge times and decreased readmission rates [4,5]. In France, RA is more often practised in community hospitals and private centres. Physicians working in non-academic centres provide a significantly greater number of anaesthetics annually than those working in teaching hospitals [6] and probably have higher success rates with regional techniques. This study has several limitations. We explored only surgical situations in which a debate between RA and GA exists and in which large numbers were available to allow statistical analysis. Detailed information was lacking as we extracted data from the questionnaire used in the survey [1]. In conclusion, this secondary analysis of the large French survey aimed at describing anaesthetic practices in France [1] showed that the use of RA in this country is primarily related to increased patient age. Other patient-, surgical- or structure-related characteristics played a less important role in determining the use of RA. D. Benhamou Department of Anesthesia and Intensive Care Medicine; Bicêtre Hospital; Le Kremlin-Bicêtre, France F. Péquignot French National Service of Causes of Death; CépiDc-INSERM; Le Vésinet, France Y. Auroy Department of Anesthesia and Critical Care Medicine; Percy Military Hospital; Clamart, France E. Jougla French National Service of Causes of Death; CépiDc-INSERM; Le Vésinet, France F. Clergue Division of Anesthesia; Cantonal University Hospital; Geneva, Switzerland M.-C. Laxenaire Department of Anesthesia and Intensive Care Medicine; Central Hospital; Nancy, France A. Lienhart Department of Anesthesia and Intensive Care Medicine; Saint-Antoine Hospital; Paris, France" @default.
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• W2004062979 date "2004-07-01" @default.
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• W2004062979 title "Factors associated with use of regional anaesthesia: a multivariate analysis in seven surgical procedures in France" @default.
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• W2004062979 doi "https://doi.org/10.1017/s026502150425712x" @default.
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