Patient Experiences as Knowledge for the Evidence Base A Qualitative Approach to Understanding Patient Experiences Regarding the Use of Regional Anesthesia for Hip and Knee Arthroplasty

Background and Objectives: It is reported that patients continue to have misgivings about regional anesthesia (RA) despite strong evidence to support its use for hip and knee replacement surgery. To date, no one has had an opportunity to study the experiences of patients who have undergone both types of anesthesia for these procedures. Methods: Using descriptive qualitative methods, 12 patients who had hip or knee replacements under both RA and GA at two different time points (excluding revisions) were interviewed using purposeful sampling until saturation had been reached. Following transcription of each tape, a small study team met over the course of several months to read and discuss each transcript. A coding template was developed, and emerging themes noted. Results: For the majority of patients, RA was either well tolerated or preferred. Having a previous negative experience with general anesthesia was common and was strongly associated with a patient's satisfaction with RA. Patients also described being highly influenced by the preference of their surgeon. Conclusions: These findings have important implications. First, many patients were surprisingly neutral about the procedure and seemed more fearful of anesthesia in general rather than of either technique specifically. This finding, combined with patient's influence by clinician preference, underscores the importance of physician support for RA. Some participants identified one of their misgivings about RA as being fear of being awake, which is consistent with the medical literature. Our findings also support the idea that from a patient's perspective, appropriate sedation while undergoing RA may be important.