Task-sharing spinal anaesthesia care in three rural Indian hospitals

BACKGROUND: Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum. METHODS: We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications. FINDINGS: Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36-0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients' experience of pain during the procedure. INTERPRETATION: This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals. TRIAL REGISTRATION NUMBER: NCT04438811

Anesthesia · General anaesthesia · Health care · Perioperative · Physical therapy · Randomized controlled trial · Spinal anesthesia · Cardiac, Anesthesia and Surgical Outcomes · Global Health and Surgery · Medicine · Trauma and Emergency Care Studies · Surgery

• Breaking ground

  Open Access•Bilal Irfan, Shayan Ali et al.•Frontiers in Public Health•2026

  Añadir item

• The effect of deploying non-physician anaesthesia providers on surgical access and capacity across Nepal’s primary and secondary government hospitals

  Open Access•Abigail G Knoble, Abigail Knoble et al.•BMJ Global Health•2026

  Añadir item

• Global Surgery 2030

  Open Access•John G Meara, Andrew J M Leather et al.•The Lancet•2015

  Añadir item

• Human resources for health in India

  Open Access•Mohan Rao, Krishna D Rao et al.•The Lancet•2011

  Añadir item