Spinal anesthesia: how can we improve patient satisfaction?

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC Since spinal anesthesia was introduced in clinics about 100 years ago, many studies have examined whether spinal anesthesia decreases operating time, mortality, cardiovascular morbidity, number of patients requiring a blood transfusion, deep vein thrombosis and pulmonary embolism, pain, opioid-related adverse effects, and the length of hospital stay when compared with general anesthesia. Macfarlane et al. [1] performed a systemic review of the contemporary literature comparing general anesthesia and/or systemic analgesia with regional anesthesia for total knee arthroplasty. They did not suggest a difference in blood loss or duration of surgery. However, regional anesthesia reduced postoperative pain and opioid-related adverse effects in patients undergoing total knee arthroplasty. Length of hospital stay may also be reduced and rehabilitation facilitated by regional anesthesia compared with general anesthesia. They found insufficient evidence from randomized, controlled trials alone to conclude whether anesthetic technique influenced mortality, cardiovascular morbidity other than postoperative hypotension, or the incidence of deep vein thrombosis and pulmonary embolism in the setting of routine thromboprophylaxis. In this issue of the journal, Rhee et al. [2] prospectively evaluated factors affecting dissatisfaction and refusal of spinal anesthesia. Anesthesiologists have a duty to inform patients about risks and alternatives to anesthetic methods. It is the basic spirit of medical ethics to allow patients to choose an anesthesia method. Anesthesiologists frequently hold a biased view when they choose the anesthetic method rather than obtain the opinion of patients, and they have a variety of reasons for choosing a given anesthetic technique. A technique may be chosen simply because we know it; it may be a favorite technique or a less familiar technique chosen to maintain competence/experience or to teach. Other reasons are a request from patients or surgeons [3]. If anesthesiologist allow patients to decide the anesthetic method, in many cases the patients say " I don't know. It's up to you " ; " Is spinal anesthesia painful? " , " I don't want to awaken during the operation " , " Will I feel pain after the operation? " , or " Does spinal anesthesia cause back pain? ". Therefore, the anesthesiologists must explain fully about the applicable anesthesia method and help patients to decide the procedure by …