Studies show that women, minorities, and those on Medicaid are less likely to receive regional anesthesia

Women, minorities and patients enrolled in Medicaid are less likely to receive regional anesthesia techniques, which consistently improve outcomes after surgery, suggests research to be presented at the 2022 Anesthesiology Annual Meeting.

The study of more than 56,000 patients is the first to report these differences in patients undergoing one of seven common surgeries, including shoulder and knee replacements. Regional anesthesia involves injecting drugs that numb the lower half of the body (spinal anaesthesia) and/or the nerve in the surgical area (nerve block). In some cases, a catheter may be placed near the nerve and numbing medication given continuously for several days after surgery.

Research has shown that regional anesthesia significantly reduces pain after surgery, limits the use of opioids, and reduces complications at the same time. The use of regional anesthesia techniques has enabled an increasing number of patients to undergo surgery under sedation rather than general anesthesia, meaning they typically do not need to place a tube down their throat to help them breathe.

“We still have work to do when it comes to providing equitable anesthesia care for some of our most common surgeries,” said Alex Beletsky, MD, lead author of the study and resident anesthesiologist at Riverside Community Hospital, California. “There may be several factors contributing to this disparity. Certain patients may be less inclined to receive regional anesthesia because they fear needles or don’t understand their benefits. Or they may simply be less consistently offered the option of regional anesthesia at a particular hospital or surgical center due to practice trends, or individual surgeon or anesthesiologist preferences. This research provides the framework for further studies to understand why this is the case and to determine how to improve access to this valuable care.”

The researchers retrospectively reviewed the records of 56,881 people aged 18 and over who underwent surgery between January 2016 and June 2021. total abdominal hysterectomy and arteriovenous (AV) fistulation for dialysis.

The main results of the study showed the following:

• Patients with Medicaid coverage were 39% less likely to have regional anesthesia than patients with private insurance.
• Patients from minority groups (e.g. black and other non-white patients) were 29% less likely to receive regional anesthesia than white patients.
• Patients with more severe disease were 12% less likely to receive regional anesthesia than those with less severe disease.
• Female patients were 11% less likely to have regional anesthesia than male patients.

“We are becoming more aware of the various benefits of regional anesthesia techniques for surgery, including improved postoperative pain, reduced postoperative opioid use, reduced nausea and vomiting, and increased same-day discharge rates,” said Dr. Beletsky. “Because these surgeries can be quite painful, patients often appreciate these pain-relieving techniques.

Provided by the American Society of Anesthesiologists