Patient-Reported Concerns and Factors Associated With Anesthetic Preference: A Cross-Sectional Study on Why Patients Choose General Over Regional Anesthesia

Background Regional anesthesia (RA) offers established perioperative benefits, yet many patients choose general anesthesia (GA) even when RA is a clinically appropriate option. Understanding patients' specific concerns and other factors associated with anesthetic preference may help improve patient-centered preoperative communication and shared decision-making. Methods This cross-sectional, questionnaire-based study included 276 adult patients scheduled for elective surgery at a public general hospital in Greece. Before preoperative anesthetic consultation, participants reported their anesthetic preference, previous RA experience, and sociodemographic and clinical characteristics. Patients who preferred GA identified their concerns regarding RA from 11 predefined items. Factors independently associated with anesthetic preference were assessed using multivariable binary logistic regression. Results Of 350 eligible patients invited, 276 completed the survey (response rate = 78.9%); 65.9% (n = 182) preferred GA and 34.1% (n = 94) preferred RA. Male sex (odds ratio {OR} = 7.12; 95% confidence interval {CI}: 3.13-16.22; p < 0.001) and previous RA experience (OR = 3.50; 95% CI: 1.70-7.19; p = 0.001) were independently associated with RA preference. Surgical specialty, education, and employment status were also independently associated with anesthetic preference. Among patients preferring GA (n = 182), the most frequently reported concerns were hearing events during surgery (90.1%, n = 164), seeing the procedure (77.5%, n = 141), and experiencing intraoperative pain (73.1%, n = 133). Concerns about permanent paralysis (40.7%, n = 74) and back injury (40.1%, n = 73) were less frequent. Among respondents to the information-related items (n = 202), 31.2% (n = 63) reported having heard that RA could cause complications, most commonly from relatives (66.7%, n = 42), while 95.5% (n = 193) wanted their anesthesiologist to address their questions about RA. Conclusions GA was preferred by approximately two-thirds of elective surgical patients despite RA being a clinically viable option. The leading concerns regarding RA centered on the awareness of the surgical environment and intraoperative pain rather than rare neurological complications. Anesthetic preference was also independently associated with previous RA experience and several patient characteristics. Identifying and directly addressing these concerns during preoperative counseling may support more informed and individualized anesthetic decision-making.