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Original article
Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion
  1. Johnny Wei Bai1,
  2. Faraj W Abdallah2,3,
  3. Melanie Cohn4,
  4. Stephanie Ladowski1,
  5. Poorna Madhusudan1 and
  6. Richard Brull1,5
  1. 1Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2Deparment of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  3. 3Department of Anesthesia and the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Psychology, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Richard Brull, Department of Anesthesia, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada; richard.brull{at}uhn.ca

Abstract

Background Poor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients’ immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion.

Methods Using a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine ‘distractor’ items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks including long-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung.

Results Among 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants’ self-rated assessment of their memory was not associated with actual recall.

Conclusion Patients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.

  • informed consent
  • nerve block
  • brachial plexus
  • ambulatory anesthesia
  • recall

https://doi.org/10.1136/rapm-2019-100858

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    Footnotes

    • Correction notice This article has been corrected since it published Online First. The author Faraj W Abdallah's name has been corrected.

    • Contributors JWB reviewed the literature, managed the raw data, performed statistical analyses, and wrote the manuscript. RB reviewed the literature, planned the study, oversaw data analysis and interpretation, and wrote the manuscript. FWA, SL, and PM reviewed the literature, helped with study design, drafted the tables, and wrote the manuscript. MC designed the participant questionnaire, oversaw measurement of memory/recall, helped with interpretation of results, and wrote the manuscript. All authors had a significant role in reviewing the manuscript.

    • Funding FWA receives research time support from the Department of Anesthesiology and Pain Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. RB receives research time support from the Evelyn Bateman Cara Operations Endowed Chair in Ambulatory Anesthesia and Women’s Health, Women’s College Hospital, Toronto, Ontario, Canada.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.