title: Patient perceptions and recall of consent for regional anaesthesia compared with consent for surgery.
abstract: OBJECTIVE
  In Britain, consent for surgery is documented using a Department of Health form signed by the surgeon and the patient. In contrast, anaesthetic procedures have no formalised consent process. Evidence on the process of consent for regional anaesthesia, and patient perceptions of this, is scarce outside obstetric practice. We aimed to determine patient recall and perceptions of consent for interscalene brachial plexus block and compared this to surgical consent for shoulder arthroplasty.
  
  
  METHODS
  Prospective observational survey.
  
  
  METHODS
  A specialist musculoskeletal centre, UK.
  
  
  METHODS
  Forty-six patients (female:male 30:16, mean age 61 years) undergoing shoulder arthroplasty with interscalene brachial plexus block.
  
  
  METHODS
  Recall and understanding of consent for regional anaesthesia and surgery was examined using a semi-structured questionnaire 1-2 days after arthroplasty. Surgical consent forms and discussions recorded by the anaesthetist were examined in participants' medical notes to compare against the level of recall. Analysis to determine statistical significance was conducted using McNemar's test.
  
  
  RESULTS
  Recall of surgical risks was overall significantly better than recall of brachial plexus block risks. Compared to their recollections of surgical risk, patients remembered fewer specific risks for brachial plexus block (p < 0.001). There were more patients unable to recall any risks when questioned about brachial plexus block than about their surgery (p < 0.05). One-third of patients did not regard the consent discussion about regional anaesthesia as important as consent for surgery and over one-quarter had not recognised the preoperative discussion about the brachial plexus block as a consent process similar to that conducted for surgery.
  
  
  CONCLUSIONS
  Fundamental misunderstandings about the consent process are prevalent. Future work in this area should seek to investigate how documentation of the consent process and patients' understanding of consent for regional anaesthesia can be improved.
authors.affiliation: Department of Anaesthesia, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK roxaneh.zarnegar@rnoh.nhs.uk.
authors.forename: Roxaneh
authors.initials: R
authors.lastname: Zarnegar
authors.affiliation: Pain Research Fellow, The Royal Marsden Hospital/The Institute of Cancer Research, London SW3 6JJ, UK.
authors.forename: Matthew R D
authors.initials: MR
authors.lastname: Brown
authors.affiliation: Department of Anaesthesia, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Henley
authors.affiliation: Specialty Registrar, Barts and the London School of Anaesthesia, London E1 1BB, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Tidman
authors.affiliation: Consultant, East & North Hertfordshire NHS Trust, Stevenage SG1 4AB, UK.
authors.forename: Ahilan
authors.initials: A
authors.lastname: Pathmanathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D065527:Brachial Plexus Block; D032882:Comprehension; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012306:Risk; D012782:Shoulder / Q000294:innervation / Q000601:surgery*; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: consent; intercalene brachial plexus block; regional anaesthesia