Spinal versus general anesthesia for lumbar discectomy. Patient-centered analysis of satisfaction with anesthesia service

Background Spinal (SA) and general anesthesia (GA) are available for lumbar disc hernia (LDH) surgery. Satisfaction with anesthesia service from a patient perspective is under-investigated and may identify areas requiring improvement leading to better care. Method Prospective, survey-based study was performed in patients, who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (POD) 0, 1, 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10. Overall satisfaction score (OSS) was calculated. Patient discomfort questionnaire as also used. Study outcomes: pain scores, satisfaction with care, discomfort reported by SA and GA group patients. Results 209 entries in GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics were equal. Proportion of patients with severe pain decreased from preoperative > 80% to 6% on POD2. Pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSS) were high: 9.71 (maximum OSS: 57% cases) in GA group and 9.74 (maximum OSS: 53.7% cases) in SA group (p > 0.05). There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort more prevalent in GA group (p < 0.05). Postoperative pain as discomfort was reported by > 50% in both SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreasing satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness and pain. Pain on POD 0 did not influence overall patient satisfaction. Association was only found when pain persisted on POD1 and POD2. Conclusion Both anesthesia methods were comparable. Patient information, anxiety management and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed irrespective of anesthesia method used.