Promoting personal autonomy is the context of awake surgery: from fear and apprehension to acceptance

Abstract

Background: Regional anaesthesia (or awake surgery) has been promoted as an excellent post-operative analgesia, encouraging earlier discharge from hospital, increased cost effectiveness and reduced perioperative morbidity. It has been advocated within the NHS as a ‘lower risk’ technique for specific patient groups. There is some evidence suggesting that patients regard it with apprehension and fear. The aim of the current study is to ascertain the experiences and decision-making process of patients’ being offered a regional anaesthetic for upper limb surgery Method: 20 patients enrolled for upper limb surgery in a hospital in South-East England were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using Thematic Analysis. Findings: Patients viewed general anaesthesia a norm for surgery. Surgery was viewed as a semi-mystical event. The choice of anaesthesia symbolised the severity of the event and adopting for a general anaesthetic allowed patients to adopt a sick role. For some patients regional anaesthesia was viewed as way to retain autonomy during surgery. Patients who defer the decision making to medical experts were apprehensive and fearful of regional anaesthetic. Patients were keen to make informed decisions and valued personalised advice on the risks and benefits of the anaesthetic. Being presented with the option the day of the surgery was not conductive to meaningful involvement and patients felt unprepared to make an informed decision. Discussion: Challenging social norms of “being asleep†during surgery requires timely, psychological preparation during perioperative assessments to ensure meaningful involvement of patients.