Delivering Essential Surgical Care for Lower-limb Musculoskeletal disorders in the Low-Resource Setting

• Published in: World journal of surgery Vol. 45; no. 10; pp. 2975 - 2981
• Main Authors: James, Deeptiman, Evans, Faye M., Rai, Ekta, Roy, Nobhojit
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-10-2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Anesthesia; Anesthesia, Local; Anesthesia, Spinal; Anesthesiology; Cardiac Surgery; Complications; Disorders; Emergency medical services; Emergency procedures; General Surgery; Humans; Infiltration; Local anesthesia; Medical personnel; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Musculoskeletal diseases; Musculoskeletal Diseases - surgery; Orthopedics; Patients; Peripheral nerves; Regional development; Retrospective Studies; Risk groups; Subarachnoid space; Surgeons; Surgery; Surgery in Low and Middle Income Countries; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-021-06211-3

Background
Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia.
Methods
A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated.
Results
During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients.
Conclusion
Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.