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

Spinal versus general anesthesia for lumbar discectomy. 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Patient-centered analysis of satisfaction with anesthesia service Marius Rimaitis, Diana Bilskienė, Kęstutis Rimaitis, Indrė Cirkelė, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7554000/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 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. Lumbar discectomy spinal versus general anesthesia satisfaction Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Intervertebral disc hernia is a common spinal pathology associated with adverse impact on patient’s quality of life and significant burden to the health care systems. Initial treatment options are conservative but substantial fraction of patients eventually undergo surgery. Even though complex spinal surgeries require general anesthesia (GA), intervertebral disc hernias predominantly occur in the lower back and can be successfully managed under spinal anesthesia (SA). Both anesthesia methods are reported to be effective and ensure satisfactory surgical conditions and patient comfort [ 1 – 4 ]. SA has been associated with lower risk of patient positioning related injuries, postoperative pulmonary complications, better postoperative pain management and lower costs [ 5 ]. GA, on the other hand, has the advantage of unlimited duration, airway control, complete immobility of the patient, and the possibility to check for neurological deficits immediately after the surgery [ 1 – 4 , 6 – 9 ]. Patient satisfaction is an important marker of overall quality of health care service provided [ 10 ]. However, studies investigating the impact of anesthesia method chosen on perioperative pain control, overall comfort and satisfaction with anesthesia service following intervertebral disc hernia surgery from the patient perspective are still lacking. Patient-centered analysis of satisfaction with anesthesia service may give more insights into the selection of optimal anesthesia approach for lumbar disc hernia surgery, identify areas requiring improvement, and lead to better care. Materials and Methods 3.1. Patient population A single-center, prospective, structured survey-based study was performed at a tertiary neurosurgical center. Patient inclusion criteria: adult patients, elective lumbar microdiscectomies (L3/4, L4/5 or L5/S1), both spinal (SA) and general anesthesia (GA) are considered as acceptable management options. Exclusion criteria: patient refusal to participate, surgery including multiple intervertebral spaces or any interspace above L3/4, spinal fusion. All eligible patients were informed about the study upon admission. The ultimate choice of anesthesia method was based on consensus made by the patient and the anesthesiologist unaware of the study. Population-based calculations identified that we needed to include at least 220 patients to make reasonable calculations [ 11 ]. Approval by the biomedical ethics committee was obtained (No. BEC-ISP(M)-79). Following written consent, from January 10th to July 31st, 2023, a total of 230 patients participated in the study. The anonymous questionnaires were filled out by the subjects themselves. Primary study outcome: patient-reported satisfaction with perioperative care in SA and GA groups. Secondary outcomes: postoperative pain scores, satisfaction with different aspects of perioperative care, and discomfort experienced by patients in SA and GA groups. 3.2. Anesthesia Spinal anesthesia (SA) was performed in the lateral decubitus position under light sedation with intravenous (IV) midazolam 1 to 5 mg, at the L3/4 or L4/5 interspace with 27G pencil point spinal needle. Following identification of the subarachnoid space by the free flow of cerebrospinal fluid, 2.8 to 3.4 ml of isobaric 0.5% spinal bupivacaine was injected. The patient was subsequently positioned in the prone position and intravenous propofol infusion was titrated to maintain moderate sedation (25–50 mcg/kg/min) throughout the surgery. No additional medications were routinely used in SA group. General anesthesia (GA) was induced with propofol 2 to 2.5 mg/kg, fentanyl 1 mcg/kg and rocuronium 0.6 mg/kg, and maintained with sevoflurane 1.0 minimum alveolar concentration. Following tracheal intubation, confirmation of tube placement and protection of the compression sites, the patient was proned for the length of surgery. GA patients were routinely given dexamethasone 4 mg and ondansetron 8 mg for nausea and vomiting prophylaxis as well as ketoprofen 1–2 mg/kg and paracetamol 1 g IV for postoperative analgesia. Following surgery, all patients were awakened in the operating room and transferred to the post-anesthesia care unit with stable vital signs. 3.3. Research instrument The questionnaire consisted of two parts. The first part included basic demographic data, medical history as well as questions about discomfort experienced and pain management in the perioperative period until postoperative day 2 (appendix No. 1). The second part assessed patient satisfaction with the service which was quantified based on the Patient satisfaction questionnaire presented by Capuzzo et al. (table No. 1) with permission by the author [ 12 , 13 ]. Each patient had to rate their satisfaction with different aspects of perioperative care on a numeric rating scale (NRS) from 0 (no satisfaction) to 10 (the maximum satisfaction possible). Overall satisfaction score (OSS) was calculated from a sum of ratings to all questions divided by the number of questions (OSS = SUM (q1: q10)/10). Based on numeric rating scale evaluations, pain was classified as mild (NRS 0–2), moderate (NRS 3–6) and severe (NRS 7–10). High satisfaction with care was considered as NRS 8–10 whereas patients reporting NRS < 8 were considered as not fully satisfied [ 14 ]. Table No. 1. The list of questions presented in the Patient satisfaction questionnaire [ 12 , 13 ] 1. How satisfied are you with the information given by the Anesthetist? 2. How satisfied are you with the attention of the Anesthetist to you? 3. How satisfied are you with treatment of pain at the site of surgery? 4. How satisfied are you with answer to your demands in the operating room? 5. How satisfied are you with the relief provided for feeling anxious or frightened? 6. How satisfied are you with feeling safe perceived in the operating room? 7. How satisfied are you with anesthesia, regarding vomiting and nausea? 8. How satisfied are you with feeling relaxed when cared for by the Anesthetist? 9. How satisfied are you with the feeling of wellbeing instilled in you by the Anesthetist? 10. How satisfied are you with kindness of caregivers in the operating room? 3.4. Data analysis The data were analyzed with SPSS Statistics version 25.0 (IBM SPSS, USA). The normality of quantitative data was assessed using the Kolmogorov–Smirnov test. Normally distributed variables were compared using Student’s t -test. Nonparametric data were compared using the Mann–Whitney U -test and Wilcoxon signed-rank test. Chi-square or Fisher’s exact test was used to analyze categorical data. Two proportion Z test was used to compare proportions. Univariate logistic regression analysis was used to identify variables associated with outcome. Data are presented as mean ± standard deviation for normally distributed variables, median (interquartile range) for nonparametric data, number (percentage) for categorical variables. P < 0.05 was considered statistically significant. Results 4.1. Population characteristics The questionnaires were properly completed by 223 patients (96.9%). Fourteen patients (6.3%) were unable to name the method of anesthesia they received. There were 209 questionnaires available for final analysis: 114 vs. 95 in GA and SA groups, respectively. Baseline patient characteristics did not differ significantly between groups (table No. 2). Table No. 2. Baseline patient characteristics. All patients (N = 223) GA group (n = 114) SA group (n = 95) p value Gender, n (%) Male 119 (53.4) 61 (53.5) 50 (52.6) 0.90 Female 104 (46.6) 53 (46.5) 45 (47.4) Age, years (mean ± SD) 52.05 ± 13.96 53.41 ± 13.72 50.15 ± 13.97 0.09 General physical state (ASA), n (%) I 52 (23.3) 22 (19.3) 26 (27.4) 0.43 II 115 (51.6) 60 (52.6) 49 (51.6) III 51 (22.9) 30 (26.3) 18 (18.9) IV 5 (2.2) 2 (1.8) 2 (2.1) Prior anesthesia, n (%) 195 (87.4) 101 (88.6) 82 (86.3) 0.62 Satisfaction with prior anesthesia (NRS), median (Q1-Q3) 10 (9–10) 10 (9–10) 10 (9–10) 0.35 Maximum satisfaction with prior anesthesia (NRS = 10), n (%) 115 (64.2) 60 (61.2) 55 (67.9) 0.35 High satisfaction with prior anesthesia (NRS ≥ 8), n (%) 171 (89.5) 88 (89.8) 73 (90.1) 0.94 Hernia symptom duration, n (%) 12 months 96 (43.3) 54 (47.4) 38 (42.9) Preoperative pain score, median (Q1-Q3) 8 (7–9) 8 (7–9) 8 (7–9) 0.69 Patient distribution on preoperative pain severity, n (%) Mild (NRS 0–2) 6 (2.8) 2 (1.9) 4 (4.3) 0.52 Moderate (NRS 3–6) 27 (12.6) 13 (12.0) 13 (14.1) Severe (NRS 7–10) 181 (84.6) 93 (86.1) 75 (81.5) GA, general anesthesia; SA, spinal anesthesia; SD, standard deviation; NRS, numeric rating scale; Q, quartile. Student’s t-test, Chi-square, or Mann-Whitney U test as applicable. Mean age in GA and SA groups was 53.41 and 50.15 years, respectively. Patient distribution by gender was similar. Most patients were ASA class II. More than 80% of the patients had previously experienced anesthesia, and 90% were highly satisfied. Preoperative pain scores were high in both groups with self-assessed pain classified as severe by 86.1% and 81.5% patients in GA and SA groups, respectively. There was 1 patient in GA and SA groups who needed revision surgery (0.9% vs 1.0%, respectively). Hospitalization time was equal with a median of 4 days in both study groups. 4.2. Perioperative pain assessment Significant time-dependent postoperative pain decreases were found within groups (figure No. 1). However, perioperative pain scores did not differ significantly between groups (table No. 3). Table No. 3. Median self-reported pain scores GA group (n = 114) SA group (n = 95) p value Preoperative 8 (7–9) 8 (7–9) 0.69 Postoperative 5.5 (3–8) 5.5 (4–7) 0.84 POD1 4 (2-5.5) 4 (2–6) 0.84 POD2 3 (2–4) 2 (1–4) 0.27 Data are expressed as median (Q1-Q3). GA, general anesthesia; SA, spinal anesthesia. Distribution of patients by pain severity was similar in study groups with no significant between-group differences (table No. 4). Table No. 4. Distribution of patients by pain categories at different time points. General anesthesia group (n = 114) Spinal anesthesia group (n = 95) Preop. POD 0 POD 1 POD 2 Preop. POD 0 POD 1 POD 2 Mild 2 (1.9) 26 (24.1) 29 (26.6) 46 (44.2) 4 (4.3) 20 (21.3) 23 (25.3) 42 (51.2) Moderate 13 (12) 45 (41.7) 64 (58.7) 52 (50) 13 (14.1) 46 (48.9) 54 (59.3) 35 (42.7) Severe 93 (86.1) 37 (34.3) 16 (14.7) 6 (5.8) 75 (81.5) 28 (29.8) 14 (15.4) 5 (6.1) Data are expressed as number (%). Preop., preoperative; POD, postoperative day. No significant between-group differences. 4.3. Patient satisfaction with anesthesia Mean overall satisfaction scores (OSS) were high with means of 9.71 ± 0.46 in general anesthesia and 9.74 ± 0.41 in spinal anesthesia groups and did not differ significantly. Maximum satisfaction (10 out of 10 in all Patient satisfaction questionnaire categories) was reported by 116 study patients, 65 (57%) vs 51 (53.7%) patients in GA and SA groups, respectively. When asked whether they would recommend the type of anesthesia they received, 99.1% of patients in the GA group, and 95.8% of patients in the SA group responded positively (p = 0.12). To identify areas for improvement, in-depth analysis of patients who did not express maximum satisfaction (N = 92) was performed. Forty-nine patients in the GA group (42.61%) and 43 patients in the SA group (45.26%), rated at least one question in the Patient satisfaction questionnaire less than 10. Ratings given to different aspects of anesthesia care were compared between study groups (table No. 5). Table No. 5. Comparison of ratings between GA and SA groups after exclusion of patients with maximum satisfaction. GA, mean (SD) GA, median (Q1-Q3) SA, mean (SD) SA, median (Q1-Q3) p* Information (q1) 9.13 (1.16) 9 (9–10) 9.58 (0.77) 10 (9–10) 0.06 Attention (q2) 9.25 (0.98) 9 (9–10) 9.26 (1.70) 10 (9–10) 0.15 Pain treatment (q3) 8.73 (0.94) 9 (8–9) 8.74 (1.59) 9 (8–10) 0.42 Answer to demands (q4) 9.15 (1.92) 10 (9–10) 9.67 (0.57) 10 (9–10) 0.09 Anxiety/fear management (q5) 9.50 (0.62) 10 (9–10) 9.57 (0.63) 10 (9–10) 0.45 Feeling of safety (q6) 9.50 (0.65) 10 (9–10) 9.67 (0.48) 10 (9–10) 0.31 Nausea/vomiting (q7) 9.27 (1.55) 10 (9–10) 9.05 (1.78) 10 (9–10) 0.54 Feeling of relaxation (q8) 9.58 (0.65) 10 (9–10) 9.69 (0.56) 10 (9–10) 0.36 Feeling of well-being (q9) 9.58 (0.65) 10 (9–10) 9.71 (0.51) 10 (9–10) 0.32 Staff kindness (q10) 9.69 (0.59) 10 (9.25-10) 9.71 (0.55) 10 (9.75-10) 0.78 GA, general anesthesia; SA, spinal anesthesia, q, question (refer to table No.1). *Mann Whitney U test. Patients in the SA group tended to give better ratings to most aspects of anesthesia care, except for nausea and vomiting. The differences were not statistically significant. All patients in both study groups were highly satisfied (NRS ≥ 8) with the management of anxiety/fear, feeling of safety, relaxation, well-being, as well as kindness of medical staff (questions No. 5, 6, 8, 9, 10). The distribution of patients who were not fully satisfied (NRS < 8) with certain aspects of anesthesia care is presented in figure No. 2. There were more patients not fully satisfied with provision of information, pain treatment and answer to demands by the anesthesiologist in the GA group, whereas a higher number of SA group patients were not fully satisfied with the management of nausea and vomiting. However, statistical significance was not reached (table No. 6). Table No. 6. Distribution of patients not satisfied with certain aspects of anesthesia care GA, n (%) SA, n (%) p* Information (q1) 3 (6.3) 1 (2.3) 0.35 Attention (q2) 2 (4.2) 2 (4.5) 0.93 Pain treatment (q3) 5 (10.4) 1 (2.3) 0.11 Answer to demands (q4) 2 (4.2) 0 (0) 0.17 Nausea/vomiting (q7) 1 (2.1) 4 (9.3) 0.13 GA, general anesthesia; SA, spinal anesthesia, q, question (refer to Appendix No.2). *Chi-square test. 4.4. Sources of patient discomfort To identify other factors associated with patient satisfaction, patients were asked about sources of discomfort experienced in the operating room, and postoperatively. A total of 63 patients (30.1%) stated to have experienced discomfort in the operating room (31 (27.2%) vs 32 (33.7%) patients in GA and SA groups, respectively). Among those patients, anxiety associated with possible medical errors was the major concern irrespective of the type of anesthesia. A larger proportion of patients were worried regarding waking up during the procedure in the SA group (37.5% vs 32.3%) whereas in the GA group, more patients were worried about the possibility of not waking up (45.2% vs 37.5%). External factors including sounds, staff behavior, body exposure and cold were more prevalent sources of discomfort for SA group patients. Discomfort due to uncomfortable position in the OR was expressed by more patients in the GA group (6.1% vs 3.2%) (figure No. 3). The differences between study groups did not reach statistical significance. Discomfort postoperatively was reported by 117 (56%) patients (62 (54.4%) vs 55 (57.9%) patients in GA and SA groups, respectively). Postoperative pain was a major concern in both groups. Throat irritation (p = 0.03) and mouth dryness (p = 0.04) was a statistically significantly more common complaint in GA group. There were no other statistically significant differences between study groups. GA group patients tended to have more headache and postoperative nausea and vomiting, whereas SA group patients expressed discomfort due to dysuria, cold and uncomfortable position more commonly. 4.5. Factors affecting patient satisfaction with anesthesia To identify factors affecting patient satisfaction, univariate logistic regression analysis was performed. Failure to achieve maximum overall satisfaction (score < 10) was chosen as a reference categorical variable. Identified associations in study patient population are presented in table No. 7. Table No. 7. Factors affecting patient satisfaction with anesthesia In the operating room Discomfort Body exposure Worry may not wake up Worry may wake up Worry about pain Worry about medical errors Overall patient satisfaction score < 10 EXP (B) 2.5 6.68 3.24 4.97 2.37 4.44 95% CI 1.37–4.60 1.86–24 1.34–7.84 1.76–14.06 1.09–5.16 1.88–10.47 p 0.03 0.004 0.009 0.003 0.03 0.01 Postoperative period Discomfort Cold PONV Dry mouth Headache Pain score (POD 1) Pain Score (POD 2) Overall patient satisfaction score < 10 EXP (B) 2.04 2.76 10.10 2.03 7.82 1.20 1.17 95% CI 1.17–3.58 1.07–7.15 2.23–45.69 1.01–4.05 2.21–27.78 1.05–1.36 1.02–1.35 p 0.01 0.04 0.03 0.05 0.001 0.006 0.03 Univariate logistic regression. CI, confidence interval; PONV, postoperative nausea and vomiting; POD, postoperative day. Univariate logistic regression analysis identified anxiety and nude body exposure as major preoperative factors associated with decreasing satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were postoperative nausea and vomiting, headache, cold, mouth dryness and pain. Interestingly, early postoperative pain (POD 0) did not influence overall patient satisfaction. Association was only found when pain persisted on POD1 and POD2. There was no association between the type of anesthesia and overall satisfaction score. Discussion Our prospective study investigated factors associated with patient satisfaction with anesthesia service during lumbar disc hernia surgery. One of the challenges faced by the scientific community is the lack of uniform definition of patient satisfaction as well as universally accepted evaluation tool [ 15 ]. We chose the questionnaire by Capuzzo et al. because it has been successfully implemented in previous studies and was suitable for both general and regional anesthesia [ 12 , 13 ]. Moreover, the use of a published assessment tool carries the advantage to present a reproducible study design. We additionally used a custom Patient discomfort questionnaire to provide more personalized approach to the sources of discomfort. The first notable finding is that more than 80% of our patients undergoing lumbar disc hernia surgery rated their preoperative pain as severe. More than 60% of patients had symptoms lasting for more than 6 months. This underlines the complexity of perioperative pain management in this patient population in whom chronic pain syndrome may have developed. Multiple randomized prospective studies have compared outcomes of lumbar spine surgery under regional versus general anesthesia [ 1 , 9 , 16 , 17 ]. Authors have repeatedly reported lower postoperative pain scores in the spinal anesthesia group and linked them with patient satisfaction [ 9 , 16 , 17 ] A meta-analysis of 3709 patients undergoing lumbar spine surgery under spinal versus general anesthesia showed that patients who received spinal anesthesia had significantly lower postoperative pain scores (mean difference: −2.80; 95% CI [− 4.55 to − 1.06], p = 0.002) [ 4 ]. In our study, the distribution of pain scores in the immediate postoperative period (POD 0) was slightly wider in the general anesthesia group. However, median pain scores as well as patient distribution by pain categories were comparable in general anesthesia and spinal anesthesia groups at all time points. The absence of significant differences between GA and SA regarding the immediate postoperative pain may be explained by the fact that the patients were asked to rate their overall pain score in the first 24 postoperative hours rather than at multiple time points on the first postoperative day. However, our target outcome was the influence of perceived pain on overall satisfaction. The analysis of not fully satisfied patients (NRS < 8) revealed more patients in the GA group, but the difference was not statistically significant. Thus, residual sensory block did not have a significant impact on postoperative pain perception on POD 0. Moreover, pain score on POD 0 was not associated with patient satisfaction, implying that anesthesia method was not a major contributor. Apparently, the availability of contemporary general anesthetics and systemic analgesics must have diminished previously reported differences in favor of SA. Postoperative pain management on postoperative days 1 and 2 was suboptimal in both groups and had adverse effect on patient satisfaction as confirmed by logistic regression analysis. We cannot differentiate whether this finding is associated with failure to meet patient expectations from surgical or anesthesiologic perspective, or both. Pain must be assessed continuously throughout the perioperative period (including subsequent postoperative days) and treated accordingly. Demirel et al. [ 17 ] found better satisfaction scores in the regional anesthesia group (4.22 vs 1.3 on a 5-point scale). Attari et al. [ 9 ] reported better satisfaction with spinal anesthesia on a dichotomous scale (Yes/No) with 100% satisfied with SA versus 67% satisfied with GA. Vural et al. [ 16 ] reported 94% of patients satisfied with spinal as compared to 74% satisfied with general anesthesia. In our study, patient overall satisfaction scores (OSS) as well as satisfaction with different aspects of anesthesia care were high with medians of 9 to 10 and did not differ significantly between groups. Similar proportions of patients expressed maximum satisfaction and would have recommended the method of anesthesia they received (99.1% vs 95.8%). Our results reflect that careful management of both anesthesia methods and adequate, patient-centered care may ensure equal patient satisfaction with perioperative care by the anesthesia team. Anxiety and nude body exposure were major intraoperative factors associated with submaximal patient satisfaction. While the anxiety associated with possible medical errors may be hardly modifiable, the anxiety associated with possible failure to wake up, possible emergence during surgery or possible pain can be managed by reassurance and careful information during pre-anesthesia consult [ 18 ]. The analysis of dissatisfied patients (NRS < 8) revealed that more GA group patients expressed the lack of information on anesthesia and inadequate answer to their needs. Anesthesiologists may tend to inform patients before regional anesthesia more thoroughly, as compared to GA group patients. This underlines the expectation of a patient to be fully informed even if he/she is going to be unconscious intraoperatively. Discomfort due to nude body exposure increased the likelihood of submaximal OSS by more than 6 times. Therefore, careful protection of patient privacy is crucial for patient satisfaction. In addition to pain on POD 1 and POD 2 in the postoperative period, PONV, mouth dryness, headache and cold were found to be associated with submaximal OSS. Logistic regression analysis confirmed that PONV increased the likelihood of submaximal OSS by 10 times. More patients in the GA group reported PONV which is an expected finding reported by other authors [ 1 , 17 , 19 ]. Interestingly, detailed analysis of not fully satisfied patients (NRS < 8) revealed more patients in the SA group. It is likely that PONV was less expected by patients in SA group, and the presence of it had more profound effect on the satisfaction score. Heidegger et al. discuss that the presence of adverse events such as PONV and postoperative pain is not the same as being dissatisfied with their management. Moreover, empathic care by the medical staff may have more effect on patient satisfaction with care than reduction of pain or PONV itself [ 15 ]. The effect of absolute pain scores and the rate of PONV on overall patient satisfaction with perioperative care may be overrated. While oropharyngeal discomfort is an expected finding after GA, headaches were also more common following GA. Thus, we can presume that lumbar puncture with atraumatic G27 spinal needle did not have significant influence on lumbar puncture-associated headache. Higher rate of headache in GA patients may be attributed to static prone position in complex with anesthetic effects on cerebral hemodynamics leading to transient intracranial pressure increase. The fact that feeling cold was found to increase the likelihood of submaximal OSS by more than 2.5 times underlines the importance of maintenance of normothermia during both regional and general anesthesia. We must note that despite detailed analysis of satisfaction from patient perspective, we did not evaluate surgeon satisfaction, perioperative turnover times and costs. They may be key factors regarding the choice of anesthesia, given that both GA and SA were equally effective and well tolerated by our patients. Another limitation is that our Patient discomfort questionnaire was custom and could have missed some other significant factors important for patient satisfaction. Conclusion Both general anesthesia and spinal anesthesia were equally effective in terms of pain management as well as from patient satisfaction perspective. No major differences in the sources of perioperative discomfort were found between groups. Patient information, anxiety management and protection of patient privacy are major preoperative factors associated with patient satisfaction. In the postoperative period following lumbar disc hernia surgery, pain and PONV management must be equally addressed irrespective of anesthesia method used. Declarations Conflict of interest Authors state to have no conflicts of interest. Funding None. Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Marius Rimaitis, Diana Bilskienė and Indrė Cirkelė. The first draft of the manuscript was written by Marius Rimaitis and all authors commented on previous versions of the manuscript. 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J Neurosurg Anesthesiol 15:185–192 Celik F, Edipoglu IS (2018) Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res 23:41. https://doi.org/10.1186/s40001-018-0339-4 Finsterwald M, Muster M, Farshad M, et al (2018) Spinal versus general anesthesia for lumbar spine surgery in high-risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 46:3–7. https://doi.org/10.1016/j.jclinane.2018.01.004 Appendix 2 The file for Appendix 2 is not available with this version Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7554000","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516354926,"identity":"a18f56c3-9767-4eb0-827d-70f1fa84716b","order_by":0,"name":"Marius Rimaitis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIie2PsQrCMBCGDwqZWrtJoFCfQDgpiIIPU5dmUezoVJziQ4gPIYJzJKMtrl27ODnkATqYFCfBxtEh3xAuBx//fwAOx58izEO6ASEedLv8V0UgJKTbIf6et+Q2ZbyvGum3sBkMZSNVXjAe3jIK2H5VpiVDGXCY8yhDXUyuOV1faF/KVGQggx0giVKjCK0EFuX+AFNMK0xppWAkrCxKrVN8YpSVSfFSArZi9QOuR06NkosS5UTfcp6lmPQUyzz1bBc4OrCz2rbFKAyrU6228VflDf34pzbB4XA4HL28ABuHTwavYfn9AAAAAElFTkSuQmCC","orcid":"","institution":"Lithuanian University of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Marius","middleName":"","lastName":"Rimaitis","suffix":""},{"id":516354927,"identity":"6fbc18b4-b1a2-4833-9cb4-732af6fe8997","order_by":1,"name":"Diana Bilskienė","email":"","orcid":"","institution":"Lithuanian University of Health 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08:04:57","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99066,"visible":true,"origin":"","legend":"","description":"","filename":"dfadb6bcaa7c4378b1733ddd3cd0c3561structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/e67b8fc3a24926a8b75f09dd.xml"},{"id":92572654,"identity":"0a73ced2-cef0-46ab-864f-ee529b4fc53f","added_by":"auto","created_at":"2025-10-01 08:04:57","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107441,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/8b958c578f591bfed7d93626.html"},{"id":92574644,"identity":"3bf59c4c-3663-42b9-8174-7e73124e1396","added_by":"auto","created_at":"2025-10-01 08:12:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105749,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSelf-reported perioperative pain scores.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as minimum, maximum, Q1, Q3, mean and median. † p \u0026lt; 0.05 between sequential time points within GA group. ‡ p \u0026lt; 0.05 between sequential time points within SA group. Wilcoxon signed ranks test.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/02d8562995291bcdfef72b07.png"},{"id":92572637,"identity":"5f228547-f02c-47e4-9641-97700ff6187d","added_by":"auto","created_at":"2025-10-01 08:04:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":90743,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of patients not satisfied with certain aspects of anesthesia care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eq, question (refer to Appendix No.2).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/18372d8b070a13a57e69cffb.png"},{"id":92574645,"identity":"eb3a4835-0956-43cc-9f3b-42f214ae8e24","added_by":"auto","created_at":"2025-10-01 08:12:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":144072,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSources of patient discomfort in the operating room\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/1bbbe176279f415e2e6b3142.png"},{"id":92572642,"identity":"4e89aa8c-6e3f-460e-8122-60011cfaa984","added_by":"auto","created_at":"2025-10-01 08:04:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":134561,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSources of patient discomfort postoperatively\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePONV, postoperative nausea and vomiting.\u003c/p\u003e\n\u003cp\u003e† and ‡, p \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/99e98cb425afca16972c6852.png"},{"id":101843777,"identity":"7d66fdbc-e9ab-4d08-ab9b-907c47d3f611","added_by":"auto","created_at":"2026-02-04 08:58:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1966717,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/26d21245-2e60-4552-be3b-dfc493671fbe.pdf"},{"id":92572639,"identity":"74ab5734-8adf-4a26-97d0-ac90685edd84","added_by":"auto","created_at":"2025-10-01 08:04:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17746,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7554000/v1/2567fbdb3d467a72fe682e97.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSpinal versus general anesthesia for lumbar discectomy. Patient-centered analysis of satisfaction with anesthesia service\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntervertebral disc hernia is a common spinal pathology associated with adverse impact on patient\u0026rsquo;s quality of life and significant burden to the health care systems. Initial treatment options are conservative but substantial fraction of patients eventually undergo surgery. Even though complex spinal surgeries require general anesthesia (GA), intervertebral disc hernias predominantly occur in the lower back and can be successfully managed under spinal anesthesia (SA). Both anesthesia methods are reported to be effective and ensure satisfactory surgical conditions and patient comfort [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. SA has been associated with lower risk of patient positioning related injuries, postoperative pulmonary complications, better postoperative pain management and lower costs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. GA, on the other hand, has the advantage of unlimited duration, airway control, complete immobility of the patient, and the possibility to check for neurological deficits immediately after the surgery [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePatient satisfaction is an important marker of overall quality of health care service provided [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, studies investigating the impact of anesthesia method chosen on perioperative pain control, overall comfort and satisfaction with anesthesia service following intervertebral disc hernia surgery from the patient perspective are still lacking.\u003c/p\u003e\u003cp\u003ePatient-centered analysis of satisfaction with anesthesia service may give more insights into the selection of optimal anesthesia approach for lumbar disc hernia surgery, identify areas requiring improvement, and lead to better care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Patient population\u003c/h2\u003e\u003cp\u003eA single-center, prospective, structured survey-based study was performed at a tertiary neurosurgical center.\u003c/p\u003e\u003cp\u003ePatient inclusion criteria: adult patients, elective lumbar microdiscectomies (L3/4, L4/5 or L5/S1), both spinal (SA) and general anesthesia (GA) are considered as acceptable management options. Exclusion criteria: patient refusal to participate, surgery including multiple intervertebral spaces or any interspace above L3/4, spinal fusion. All eligible patients were informed about the study upon admission. The ultimate choice of anesthesia method was based on consensus made by the patient and the anesthesiologist unaware of the study.\u003c/p\u003e\u003cp\u003ePopulation-based calculations identified that we needed to include at least 220 patients to make reasonable calculations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Approval by the biomedical ethics committee was obtained (No. BEC-ISP(M)-79). Following written consent, from January 10th to July 31st, 2023, a total of 230 patients participated in the study. The anonymous questionnaires were filled out by the subjects themselves.\u003c/p\u003e\u003cp\u003ePrimary study outcome: patient-reported satisfaction with perioperative care in SA and GA groups. Secondary outcomes: postoperative pain scores, satisfaction with different aspects of perioperative care, and discomfort experienced by patients in SA and GA groups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Anesthesia\u003c/h2\u003e\u003cp\u003eSpinal anesthesia (SA) was performed in the lateral decubitus position under light sedation with intravenous (IV) midazolam 1 to 5 mg, at the L3/4 or L4/5 interspace with 27G pencil point spinal needle. Following identification of the subarachnoid space by the free flow of cerebrospinal fluid, 2.8 to 3.4 ml of isobaric 0.5% spinal bupivacaine was injected. The patient was subsequently positioned in the prone position and intravenous propofol infusion was titrated to maintain moderate sedation (25\u0026ndash;50 mcg/kg/min) throughout the surgery. No additional medications were routinely used in SA group. General anesthesia (GA) was induced with propofol 2 to 2.5 mg/kg, fentanyl 1 mcg/kg and rocuronium 0.6 mg/kg, and maintained with sevoflurane 1.0 minimum alveolar concentration. Following tracheal intubation, confirmation of tube placement and protection of the compression sites, the patient was proned for the length of surgery. GA patients were routinely given dexamethasone 4 mg and ondansetron 8 mg for nausea and vomiting prophylaxis as well as ketoprofen 1\u0026ndash;2 mg/kg and paracetamol 1 g IV for postoperative analgesia. Following surgery, all patients were awakened in the operating room and transferred to the post-anesthesia care unit with stable vital signs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Research instrument\u003c/h2\u003e\u003cp\u003eThe questionnaire consisted of two parts. The first part included basic demographic data, medical history as well as questions about discomfort experienced and pain management in the perioperative period until postoperative day 2 (appendix No. 1).\u003c/p\u003e\u003cp\u003eThe second part assessed patient satisfaction with the service which was quantified based on the Patient satisfaction questionnaire presented by \u003cem\u003eCapuzzo\u003c/em\u003e et al. (table No. 1) with permission by the author [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Each patient had to rate their satisfaction with different aspects of perioperative care on a numeric rating scale (NRS) from 0 (no satisfaction) to 10 (the maximum satisfaction possible). Overall satisfaction score (OSS) was calculated from a sum of ratings to all questions divided by the number of questions (OSS\u0026thinsp;=\u0026thinsp;SUM (q1: q10)/10). Based on numeric rating scale evaluations, pain was classified as mild (NRS 0\u0026ndash;2), moderate (NRS 3\u0026ndash;6) and severe (NRS 7\u0026ndash;10). High satisfaction with care was considered as NRS 8\u0026ndash;10 whereas patients reporting NRS\u0026thinsp;\u0026lt;\u0026thinsp;8 were considered as not fully satisfied [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable No. 1. The list of questions presented in the Patient satisfaction questionnaire\u003c/b\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with the information given by the Anesthetist?\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with the attention of the Anesthetist to you?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with treatment of pain at the site of surgery?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with answer to your demands in the operating room?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with the relief provided for feeling anxious or frightened?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with feeling safe perceived in the operating room?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with anesthesia, regarding vomiting and nausea?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with feeling relaxed when cared for by the Anesthetist?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with the feeling of wellbeing instilled in you by the Anesthetist?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow satisfied are you with kindness of caregivers in the operating room?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Data analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed with SPSS Statistics version 25.0 (IBM SPSS, USA). The normality of quantitative data was assessed using the Kolmogorov\u0026ndash;Smirnov test. Normally distributed variables were compared using Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. Nonparametric data were compared using the Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e-test and Wilcoxon signed-rank test. Chi-square or Fisher\u0026rsquo;s exact test was used to analyze categorical data. Two proportion Z test was used to compare proportions. Univariate logistic regression analysis was used to identify variables associated with outcome. Data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for normally distributed variables, median (interquartile range) for nonparametric data, number (percentage) for categorical variables. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003e4.1. Population characteristics\u003c/h2\u003e\n \u003cp\u003eThe questionnaires were properly completed by 223 patients (96.9%). Fourteen patients (6.3%) were unable to name the method of anesthesia they received. There were 209 questionnaires available for final analysis: 114 vs. 95 in GA and SA groups, respectively. Baseline patient characteristics did not differ significantly between groups (table No. 2).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 2. Baseline patient characteristics.\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients (N = 223)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA group (n = 114)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSA group (n = 95)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAge, years (mean ± SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.05 ± 13.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.41 ± 13.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.15 ± 13.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003eGeneral physical state (ASA), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePrior anesthesia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195 (87.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (86.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eSatisfaction with prior anesthesia (NRS), median (Q1-Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMaximum satisfaction with prior anesthesia (NRS = 10), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHigh satisfaction with prior anesthesia (NRS ≥ 8), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (90.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003eHernia symptom duration, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1–6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6–12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePreoperative pain score, median (Q1-Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003ePatient distribution on preoperative pain severity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMild (NRS 0–2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModerate (NRS 3–6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSevere (NRS 7–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e181 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eGA, general anesthesia; SA, spinal anesthesia; SD, standard deviation; NRS, numeric rating scale; Q, quartile.\u003c/p\u003e\n \u003cp\u003eStudent’s t-test, Chi-square, or Mann-Whitney U test as applicable.\u003c/p\u003e\n \u003cp\u003eMean age in GA and SA groups was 53.41 and 50.15 years, respectively. Patient distribution by gender was similar. Most patients were ASA class II. More than 80% of the patients had previously experienced anesthesia, and 90% were highly satisfied. Preoperative pain scores were high in both groups with self-assessed pain classified as severe by 86.1% and 81.5% patients in GA and SA groups, respectively. There was 1 patient in GA and SA groups who needed revision surgery (0.9% vs 1.0%, respectively). Hospitalization time was equal with a median of 4 days in both study groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003e4.2. Perioperative pain assessment\u003c/h2\u003e\n \u003cp\u003eSignificant time-dependent postoperative pain decreases were found within groups (figure No. 1). However, perioperative pain scores did not differ significantly between groups (table No. 3).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 3. Median self-reported pain scores\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA group (n = 114)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSA group (n = 95)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5 (3–8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5 (4–7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOD1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (2-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (2–6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOD2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2–4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1–4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eData are expressed as median (Q1-Q3). GA, general anesthesia; SA, spinal anesthesia.\u003c/p\u003e\n \u003cp\u003eDistribution of patients by pain severity was similar in study groups with no significant between-group differences (table No. 4).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 4. Distribution of patients by pain categories at different time points.\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eGeneral anesthesia group (n = 114)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSpinal anesthesia group (n = 95)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreop.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreop.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eData are expressed as number (%). Preop., preoperative; POD, postoperative day.\u003c/p\u003e\n \u003cp\u003eNo significant between-group differences.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003e4.3. Patient satisfaction with anesthesia\u003c/h2\u003e\n \u003cp\u003eMean overall satisfaction scores (OSS) were high with means of 9.71 ± 0.46 in general anesthesia and 9.74 ± 0.41 in spinal anesthesia groups and did not differ significantly. Maximum satisfaction (10 out of 10 in all Patient satisfaction questionnaire categories) was reported by 116 study patients, 65 (57%) vs 51 (53.7%) patients in GA and SA groups, respectively.\u003c/p\u003e\n \u003cp\u003eWhen asked whether they would recommend the type of anesthesia they received, 99.1% of patients in the GA group, and 95.8% of patients in the SA group responded positively (p = 0.12).\u003c/p\u003e\n \u003cp\u003eTo identify areas for improvement, in-depth analysis of patients who did not express maximum satisfaction (N = 92) was performed. Forty-nine patients in the GA group (42.61%) and 43 patients in the SA group (45.26%), rated at least one question in the Patient satisfaction questionnaire less than 10. Ratings given to different aspects of anesthesia care were compared between study groups (table No. 5).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 5. Comparison of ratings between GA and SA groups after exclusion of patients with maximum satisfaction.\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA, mean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA, median (Q1-Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSA, mean (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSA, median (Q1-Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformation (q1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.13 (1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttention (q2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.25 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.26 (1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain treatment (q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.73 (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8–9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.74 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnswer to demands (q4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.15 (1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety/fear management (q5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.50 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.57 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling of safety (q6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.50 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.67 (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea/vomiting (q7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.27 (1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.05 (1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling of relaxation (q8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69 (0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling of well-being (q9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.58 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9–10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStaff kindness (q10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.69 (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9.25-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.71 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (9.75-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eGA, general anesthesia; SA, spinal anesthesia, q, question (refer to table No.1). *Mann Whitney U test.\u003c/p\u003e\n \u003cp\u003ePatients in the SA group tended to give better ratings to most aspects of anesthesia care, except for nausea and vomiting. The differences were not statistically significant.\u003c/p\u003e\n \u003cp\u003eAll patients in both study groups were highly satisfied (NRS ≥ 8) with the management of anxiety/fear, feeling of safety, relaxation, well-being, as well as kindness of medical staff (questions No. 5, 6, 8, 9, 10).\u003c/p\u003e\n \u003cp\u003eThe distribution of patients who were not fully satisfied (NRS \u0026lt; 8) with certain aspects of anesthesia care is presented in figure No. 2. There were more patients not fully satisfied with provision of information, pain treatment and answer to demands by the anesthesiologist in the GA group, whereas a higher number of SA group patients were not fully satisfied with the management of nausea and vomiting. However, statistical significance was not reached (table No. 6).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 6. Distribution of patients not satisfied with certain aspects of anesthesia care\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabf\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSA, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInformation (q1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttention (q2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain treatment (q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnswer to demands (q4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea/vomiting (q7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eGA, general anesthesia; SA, spinal anesthesia, q, question (refer to Appendix No.2). *Chi-square test.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003e4.4. Sources of patient discomfort\u003c/h2\u003e\n \u003cp\u003eTo identify other factors associated with patient satisfaction, patients were asked about sources of discomfort experienced in the operating room, and postoperatively.\u003c/p\u003e\n \u003cp\u003eA total of 63 patients (30.1%) stated to have experienced discomfort in the operating room (31 (27.2%) vs 32 (33.7%) patients in GA and SA groups, respectively).\u003c/p\u003e\n \u003cp\u003eAmong those patients, anxiety associated with possible medical errors was the major concern irrespective of the type of anesthesia. A larger proportion of patients were worried regarding waking up during the procedure in the SA group (37.5% vs 32.3%) whereas in the GA group, more patients were worried about the possibility of not waking up (45.2% vs 37.5%). External factors including sounds, staff behavior, body exposure and cold were more prevalent sources of discomfort for SA group patients. Discomfort due to uncomfortable position in the OR was expressed by more patients in the GA group (6.1% vs 3.2%) (figure No. 3). The differences between study groups did not reach statistical significance.\u003c/p\u003e\n \u003cp\u003eDiscomfort postoperatively was reported by 117 (56%) patients (62 (54.4%) vs 55 (57.9%) patients in GA and SA groups, respectively). Postoperative pain was a major concern in both groups. Throat irritation (p = 0.03) and mouth dryness (p = 0.04) was a statistically significantly more common complaint in GA group. There were no other statistically significant differences between study groups. GA group patients tended to have more headache and postoperative nausea and vomiting, whereas SA group patients expressed discomfort due to dysuria, cold and uncomfortable position more commonly.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003e4.5. Factors affecting patient satisfaction with anesthesia\u003c/h2\u003e\n \u003cp\u003eTo identify factors affecting patient satisfaction, univariate logistic regression analysis was performed. Failure to achieve maximum overall satisfaction (score \u0026lt; 10) was chosen as a reference categorical variable. Identified associations in study patient population are presented in table No. 7.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable No. 7. Factors affecting patient satisfaction with anesthesia\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tabg\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIn the operating room\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiscomfort\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBody exposure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorry may not wake up\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorry may wake up\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorry about pain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWorry about medical errors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eOverall patient satisfaction score \u0026lt; 10\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEXP (B)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6.68\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3.24\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.37–4.60\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.86–24\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.34–7.84\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.76–14.06\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.09–5.16\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.88–10.47\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscomfort\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCold\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePONV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry mouth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeadache\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain score (POD 1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score (POD 2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eOverall patient satisfaction score \u0026lt; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEXP (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17–3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07–7.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.23–45.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01–4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.21–27.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05–1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02–1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eUnivariate logistic regression. CI, confidence interval; PONV, postoperative nausea and vomiting; POD, postoperative day.\u003c/p\u003e\n \u003cp\u003eUnivariate logistic regression analysis identified anxiety and nude body exposure as major preoperative factors associated with decreasing satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were postoperative nausea and vomiting, headache, cold, mouth dryness and pain. Interestingly, early postoperative pain (POD 0) did not influence overall patient satisfaction. Association was only found when pain persisted on POD1 and POD2.\u003c/p\u003e\n \u003cp\u003eThere was no association between the type of anesthesia and overall satisfaction score.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur prospective study investigated factors associated with patient satisfaction with anesthesia service during lumbar disc hernia surgery. One of the challenges faced by the scientific community is the lack of uniform definition of patient satisfaction as well as universally accepted evaluation tool [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We chose the questionnaire by \u003cem\u003eCapuzzo\u003c/em\u003e et al. because it has been successfully implemented in previous studies and was suitable for both general and regional anesthesia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, the use of a published assessment tool carries the advantage to present a reproducible study design. We additionally used a custom Patient discomfort questionnaire to provide more personalized approach to the sources of discomfort.\u003c/p\u003e\u003cp\u003eThe first notable finding is that more than 80% of our patients undergoing lumbar disc hernia surgery rated their preoperative pain as severe. More than 60% of patients had symptoms lasting for more than 6 months. This underlines the complexity of perioperative pain management in this patient population in whom chronic pain syndrome may have developed.\u003c/p\u003e\u003cp\u003eMultiple randomized prospective studies have compared outcomes of lumbar spine surgery under regional versus general anesthesia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Authors have repeatedly reported lower postoperative pain scores in the spinal anesthesia group and linked them with patient satisfaction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] A meta-analysis of 3709 patients undergoing lumbar spine surgery under spinal versus general anesthesia showed that patients who received spinal anesthesia had significantly lower postoperative pain scores (mean difference: \u0026minus;2.80; 95% CI [\u0026minus;\u0026thinsp;4.55 to \u0026minus;\u0026thinsp;1.06], p\u0026thinsp;=\u0026thinsp;0.002) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, the distribution of pain scores in the immediate postoperative period (POD 0) was slightly wider in the general anesthesia group. However, median pain scores as well as patient distribution by pain categories were comparable in general anesthesia and spinal anesthesia groups at all time points. The absence of significant differences between GA and SA regarding the immediate postoperative pain may be explained by the fact that the patients were asked to rate their overall pain score in the first 24 postoperative hours rather than at multiple time points on the first postoperative day. However, our target outcome was the influence of perceived pain on overall satisfaction. The analysis of not fully satisfied patients (NRS\u0026thinsp;\u0026lt;\u0026thinsp;8) revealed more patients in the GA group, but the difference was not statistically significant. Thus, residual sensory block did not have a significant impact on postoperative pain perception on POD 0. Moreover, pain score on POD 0 was not associated with patient satisfaction, implying that anesthesia method was not a major contributor. Apparently, the availability of contemporary general anesthetics and systemic analgesics must have diminished previously reported differences in favor of SA.\u003c/p\u003e\u003cp\u003ePostoperative pain management on postoperative days 1 and 2 was suboptimal in both groups and had adverse effect on patient satisfaction as confirmed by logistic regression analysis. We cannot differentiate whether this finding is associated with failure to meet patient expectations from surgical or anesthesiologic perspective, or both. Pain must be assessed continuously throughout the perioperative period (including subsequent postoperative days) and treated accordingly.\u003c/p\u003e\u003cp\u003e\u003cem\u003eDemirel\u003c/em\u003e et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found better satisfaction scores in the regional anesthesia group (4.22 vs 1.3 on a 5-point scale). \u003cem\u003eAttari\u003c/em\u003e et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported better satisfaction with spinal anesthesia on a dichotomous scale (Yes/No) with 100% satisfied with SA versus 67% satisfied with GA. \u003cem\u003eVural\u003c/em\u003e et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported 94% of patients satisfied with spinal as compared to 74% satisfied with general anesthesia.\u003c/p\u003e\u003cp\u003eIn our study, patient overall satisfaction scores (OSS) as well as satisfaction with different aspects of anesthesia care were high with medians of 9 to 10 and did not differ significantly between groups. Similar proportions of patients expressed maximum satisfaction and would have recommended the method of anesthesia they received (99.1% vs 95.8%). Our results reflect that careful management of both anesthesia methods and adequate, patient-centered care may ensure equal patient satisfaction with perioperative care by the anesthesia team.\u003c/p\u003e\u003cp\u003eAnxiety and nude body exposure were major intraoperative factors associated with submaximal patient satisfaction. While the anxiety associated with possible medical errors may be hardly modifiable, the anxiety associated with possible failure to wake up, possible emergence during surgery or possible pain can be managed by reassurance and careful information during pre-anesthesia consult [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The analysis of dissatisfied patients (NRS\u0026thinsp;\u0026lt;\u0026thinsp;8) revealed that more GA group patients expressed the lack of information on anesthesia and inadequate answer to their needs. Anesthesiologists may tend to inform patients before regional anesthesia more thoroughly, as compared to GA group patients. This underlines the expectation of a patient to be fully informed even if he/she is going to be unconscious intraoperatively. Discomfort due to nude body exposure increased the likelihood of submaximal OSS by more than 6 times. Therefore, careful protection of patient privacy is crucial for patient satisfaction.\u003c/p\u003e\u003cp\u003eIn addition to pain on POD 1 and POD 2 in the postoperative period, PONV, mouth dryness, headache and cold were found to be associated with submaximal OSS. Logistic regression analysis confirmed that PONV increased the likelihood of submaximal OSS by 10 times. More patients in the GA group reported PONV which is an expected finding reported by other authors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Interestingly, detailed analysis of not fully satisfied patients (NRS\u0026thinsp;\u0026lt;\u0026thinsp;8) revealed more patients in the SA group. It is likely that PONV was less expected by patients in SA group, and the presence of it had more profound effect on the satisfaction score.\u003c/p\u003e\u003cp\u003e\u003cem\u003eHeidegger\u003c/em\u003e et al. discuss that the presence of adverse events such as PONV and postoperative pain is not the same as being dissatisfied with their management. Moreover, empathic care by the medical staff may have more effect on patient satisfaction with care than reduction of pain or PONV itself [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The effect of absolute pain scores and the rate of PONV on overall patient satisfaction with perioperative care may be overrated.\u003c/p\u003e\u003cp\u003eWhile oropharyngeal discomfort is an expected finding after GA, headaches were also more common following GA. Thus, we can presume that lumbar puncture with atraumatic G27 spinal needle did not have significant influence on lumbar puncture-associated headache. Higher rate of headache in GA patients may be attributed to static prone position in complex with anesthetic effects on cerebral hemodynamics leading to transient intracranial pressure increase.\u003c/p\u003e\u003cp\u003eThe fact that feeling cold was found to increase the likelihood of submaximal OSS by more than 2.5 times underlines the importance of maintenance of normothermia during both regional and general anesthesia.\u003c/p\u003e\u003cp\u003eWe must note that despite detailed analysis of satisfaction from patient perspective, we did not evaluate surgeon satisfaction, perioperative turnover times and costs. They may be key factors regarding the choice of anesthesia, given that both GA and SA were equally effective and well tolerated by our patients. Another limitation is that our Patient discomfort questionnaire was custom and could have missed some other significant factors important for patient satisfaction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBoth general anesthesia and spinal anesthesia were equally effective in terms of pain management as well as from patient satisfaction perspective. No major differences in the sources of perioperative discomfort were found between groups. Patient information, anxiety management and protection of patient privacy are major preoperative factors associated with patient satisfaction. In the postoperative period following lumbar disc hernia surgery, pain and PONV management must be equally addressed irrespective of anesthesia method used.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors state to have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Marius Rimaitis, Diana Bilskienė and Indrė Cirkelė. The first draft of the manuscript was written by Marius Rimaitis and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJellish WS, Thalji Z, Stevenson K, Shea J (1996) A Prospective Randomized Study Comparing Short-and Intermediate-Term Perioperative Outcome Variables After Spinal or General Anesthesia for lumbar Disk and Laminectomy Surgery. Anesth Analg 83:559\u0026ndash;564\u003c/li\u003e\n\u003cli\u003eMcLain RF, Kalfas I, Bell GR, et al (2005) Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2:17\u0026ndash;22. https://doi.org/10.3171/spi.2005.2.1.0017\u003c/li\u003e\n\u003cli\u003eMorris MT, Morris J, Wallace C, et al (2019) An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings. Global Spine J 9:368\u0026ndash;374. https://doi.org/10.1177/2192568218795867\u003c/li\u003e\n\u003cli\u003ePerez-Roman RJ, Govindarajan V, Bryant JP, Wang MY (2021) Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg Focus 51:E7. https://doi.org/10.3171/2021.9.FOCUS21464\u003c/li\u003e\n\u003cli\u003eDe Rojas JO, Syre P, Welch WC (2014) Regional anesthesia versus general anesthesia for surgery on the lumbar spine: A review of the modern literature. Clin Neurol Neurosurg 119:39\u0026ndash;43\u003c/li\u003e\n\u003cli\u003eAhmed Jonayed S, Alam MS, Al Mamun Choudhury A, et al (2021) Efficacy, safety, and reliability of surgery on the lumbar spine under general versus spinal anesthesia- an analysis of 64 cases. J Clin Orthop Trauma 16:176\u0026ndash;181. https://doi.org/10.1016/j.jcot.2020.12.032\u003c/li\u003e\n\u003cli\u003eSarkar S, Banerji A, Chattopadhyaya A, Banerjee S (2021) Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases. J Clin Orthop Trauma 18:205\u0026ndash;208. https://doi.org/10.1016/j.jcot.2021.04.026\u003c/li\u003e\n\u003cli\u003eSharma N, Piazza M, Marcotte PJ, et al (2019) Implications of anesthetic approach, spinal versus general, for the treatment of spinal disc herniation. J Neurosurg Spine 30:78\u0026ndash;82. https://doi.org/10.3171/2018.7.SPINE18460\u003c/li\u003e\n\u003cli\u003eAttari MA, Mirhosseini A, Honarmand A, Safavi MR (2011) Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. 16:524\u0026ndash;529\u003c/li\u003e\n\u003cli\u003eBello C, N\u0026uuml;bling M, Luedi MM, Heidegger T (2023) Patient satisfaction in anesthesiology: a narrative review. Curr Opin Anaesthesiol 36:452\u0026ndash;459\u003c/li\u003e\n\u003cli\u003eSchwarze J (1993) Grundlagen der Statistik, 5th ed. Neue Wirtschaftsbriefe, Herne/Berlin\u003c/li\u003e\n\u003cli\u003eCapuzzo M, Landi F, Bassani A, et al (2005) Emotional and interpersonal factors are most important for patient satisfaction with anaesthesia. Acta Anaesthesiol Scand 49:735\u0026ndash;742. https://doi.org/10.1111/j.1399-6576.2005.00738\u003c/li\u003e\n\u003cli\u003eCapuzzo M, Gilli G, Paparella L, et al (2007) Factors predictive of patient satisfaction with anesthesia. Anesth Analg 105:435\u0026ndash;442. https://doi.org/10.1213/01.ane.0000270208.99982.88\u003c/li\u003e\n\u003cli\u003eL\u0026uuml;tzner C, Beyer F, David L, L\u0026uuml;tzner J (2023) Fulfilment of patients\u0026rsquo; mandatory expectations are crucial for satisfaction: a study amongst 352 patients after total knee arthroplasty (TKA). Knee Surgery, Sports Traumatology, Arthroscopy 31:3755\u0026ndash;3764. https://doi.org/10.1007/s00167-022-07301\u003c/li\u003e\n\u003cli\u003eHeidegger T, Saal D, N\u0026uuml;bling M (2013) Patient satisfaction with anaesthesia - Part 1: Satisfaction as part of outcome - And what satisfies patients. Anaesthesia 68:1165\u0026ndash;1172. https://doi.org/10.1111/anae.12347\u003c/li\u003e\n\u003cli\u003eVural C, Yorukoglu D (2014) Comparison of patient satisfaction and cost in spinal and general anesthesia for lumbar disc surgery. Turk Neurosurg 24:380\u0026ndash;384. https://doi.org/10.5137/1019-5149.JTN.8575-13.0\u003c/li\u003e\n\u003cli\u003eBekir Demirel C, Kalayci M, Ozkocak I, et al (2003) A Prospective Randomized Study Comparing Perioperative Outcome Variables After Epidural or General Anesthesia for Lumbar Disc Surgery. J Neurosurg Anesthesiol 15:185\u0026ndash;192\u003c/li\u003e\n\u003cli\u003eCelik F, Edipoglu IS (2018) Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res 23:41. https://doi.org/10.1186/s40001-018-0339-4\u003c/li\u003e\n\u003cli\u003eFinsterwald M, Muster M, Farshad M, et al (2018) Spinal versus general anesthesia for lumbar spine surgery in high-risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 46:3\u0026ndash;7. https://doi.org/10.1016/j.jclinane.2018.01.004\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Appendix 2","content":" \u003cp\u003eThe file for Appendix 2 is not available with this version \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lumbar discectomy, spinal versus general anesthesia, satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-7554000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7554000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSpinal (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.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eProspective, 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e209 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\u0026thinsp;\u0026gt;\u0026thinsp;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\u0026thinsp;\u0026gt;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Postoperative pain as discomfort was reported by \u0026gt;\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBoth 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.\u003c/p\u003e","manuscriptTitle":"Spinal versus general anesthesia for lumbar discectomy. Patient-centered analysis of satisfaction with anesthesia service","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 08:04:52","doi":"10.21203/rs.3.rs-7554000/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d443bf1d-5501-47ac-8f08-66a75fe0505b","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T08:55:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 08:04:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7554000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7554000","identity":"rs-7554000","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}