title: Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital.
abstract: OBJECTIVE
  Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries.
  
  
  METHODS
  A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal.
  
  
  RESULTS
  Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively.
  
  
  CONCLUSIONS
  This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information.
authors.affiliation: Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Asma Abdus
authors.initials: AA
authors.lastname: Salam
authors.affiliation: Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Gauhar
authors.initials: G
authors.lastname: Afshan
keywords: Elderly population; orthopedic procedures; refusal for regional anesthesia