Experience of Anaesthesia in Orthopaedic Surgery at a Tertiary Hospital in South-South Nigeria: A Retrospective Study (2020-2025)

Abstract

Background: Orthopaedic surgery accounts for a substantial portion of surgical workload in tertiary hospitals, particularly in low- and middle-income countries where trauma, especially from road traffic accidents, remains a major public health challenge. Anaesthesia for orthopaedic procedures requires careful selection of techniques based on patient characteristics, surgical demands, and resource availability. Objective: To review the anaesthetic management of orthopaedic surgeries over a five-year period in a tertiary hospital in South-South Nigeria, assessing patient demographics, surgical characteristics, and anaesthetic techniques employed. Methods: A retrospective review was conducted on all orthopaedic surgeries performed at the University of Port Harcourt Teaching Hospital between 2020 and 2025. Data extracted from theatre records included demographics, type and site of surgery, ASA classification, and anaesthetic technique. Analysis was performed using SPSS version 25.0 and presented as frequencies and means. Results: A total of 816 orthopaedic procedures were performed. The mean age was 37.4 ± 20.2 years, with patients ranging from 2 to 102 years, M:F ratio of 2:1. Elective surgeries accounted for 67% of cases, while 33% were emergencies. Most patients were ASA I (60.2%), with 12% classified as ASA III–IV. Lower limb surgeries predominated (82.7%), followed by upper limb (7.5%) and spine procedures (7.1%). Spinal anaesthesia was the most frequently used technique (40.4%), followed by general anaesthesia (34.6%) and combined spinal epidural (16.2%). Peripheral nerve blocks (2.5%), epidural anaesthesia (0.5%), intravenous regional anaesthesia (0.4%), local anaesthesia (4.1%), and TIVA (1.5%) constituted the remainder. Conclusion: Orthopaedic surgeries represent a major component of the surgical caseload, predominantly affecting young adults with trauma-related lower limb injuries. Neuraxial anaesthesia particularly spinal anaesthesia was the most used technique. While practice patterns align with regional trends, the limited use of peripheral nerve blocks highlights opportunities for expanding regional anaesthesia capacity through improved training and resource investment. The study also highlights the need for further research into the regional anaesthesia capacity or areas for potential improvement in anaesthetic practices.