Minority and low-income patients are less likely than those who are white or more well off to agree to post-surgery epidural pain relief, according to new research from physicians at the University of Pennsylvania School of Medicine. The study, published recently in the journal Anesthesia and Analgesia, examined how race, economic and educational status may influence health care choices when access to care isn't a factor. In the overall analysis, education and income were not as important as race in determining epidural acceptance, but the researchers say the costs of improper pain treatment after surgery are large for any patient group.
"Epidurals are more effective for relieving postoperative pain, and higher levels of pain have been linked to the development of chronic pain," says E. Andrew Ochroch, MD, an associate professor and director of clinical research in the Department of Anesthesiology and Critical Care. "Consequently, if African Americans are either denied or denying themselves epidural for pain relief, then they may be at greater risk for postoperative complications."
Patients who receive perioperative epidural analgesia during major upper abdominal or chest surgery, for instance, have improved lung function, which reduces their risk of pneumonia. And since they're able to get out of bed to move around sooner, they're primed to go home sooner than those who have severe pain. Research also shows that patients who have high levels of perioperative pain are more apt to suffer from chronic pain later on.
Using a short, scripted interview developed by a panel of anesthesiologists, neurologists and chronic pain specialists, prospective surgery patients were screened to assess what they already knew about epidurals and what experiences, if any, they'd had with the technique before.
Physicians collected data from 1,193 patients between late August 2004 and early January 2005. Sixty four percent of all patients said they would accept an epidural if it was recommended by an anesthesiologist, while 36 percent said they would refuse. When asked if an additional recommendation from the surgeon would make them consent, acceptance rose to 78 percent. But when examining differences based on race, African American patients were less likely to say they would accept an epidural under any circumstances.
Socio-economic status also appeared to influence consent. Participants who worked full- or part-time were more likely to accept an epidural compared to those who were unemployed. Even at higher income levels -- $50,000 to $75,000 -- white patients were more likely than black patients to accept an epidural.
The researchers hope to use this new data to help surgeons and other staff members find innovative ways to discuss perioperative anesthesia as a critical part of a patient's care, and build anesthesia awareness components into Penn's existing community and church-based health outreach initiatives.
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