Perioperative regional anaesthesia and postoperative longer-term outcomes

Abstract

Regional anaesthesia provides effective anaesthesia and analgesia in the perioperative setting. Central neuraxial blocks—that is, spinal and epidural blocks—are well established as an alternative or adjunct to general anaesthesia. Peripheral blocks may be used as part of multimodal anaesthesia/analgesia in perioperative practice, reducing the need for opioid analgesics and enhancing early recovery. Furthermore, regional anaesthesia has increased in popularity and may be done with improved ease and safety with the introduction of ultrasound-guided techniques. The effects of local anaesthetics and regional anaesthesia on long-term outcomes such as morbidity, mortality, the quality of recovery beyond the duration of analgesia, and whether it can expedite the resumption of activities of daily living are less clear. It has also been suggested that regional anaesthesia may impact the risk of metastasis after cancer surgery. This article provides an overview of current evidence around quality of recovery, risk for delirium, long-term effects, and possible impact on cancer disease progression associated with the clinical use of local and regional anaesthetic techniques. In summary, there is still a lack of robust data that regional anaesthesia has a clinical impact beyond its well-acknowledged beneficial effects of reducing pain, reduced opioid consumption, and improved quality of early recovery. Further high-quality prospective studies on long-term outcomes are warranted.

Frailty and anesthesia – risks during and post-surgery

“…Epidural anesthesia is undoubtedly the most effective form of pain relief and reduces opioid consumption. 86 A recent meta-analysis concluded that epidural in addition to GA reduced both postoperative mortality and morbidity; however, there were higher rates of hypotension and urinary retention and a technical failure rate of 6.1%. 87 The mean age of the participants in the 125 trials included in this meta-analysis was not reported, and it is likely that they represent the general population undergoing surgery, which may benefit less from regional anesthesia than those who are frail.…”

Anaesthesia for open wrist fracture surgery in adults/elderly

“…The application of local anaesthetics in the wound area, site for incision, or as a peripheral block, is a basic part of the multi-modal analgesia concept. The effects of peripheral block on early pain, reducing the need for opioid analgesics are well-known 16 . The effects beyond the early period and the duration of the pharmacological local block is less well documented 17 .…”

Influence of pain relief management on early patents rehabilitation after total hip replacement

“…На швидкість відновлення після цього втручання, окрім ортопедичних чинників, впливає мотивація й адекватний контроль болю [3]. Регіональна анестезія забезпечує ефективне знеболювання в периопераційному періоді [9,10]. Центральні нейроаксіальні блоки, тобто спінальні та епідуральні, добре зарекомендували себе як альтернатива або доповнення до загальної анестезії.…”

“…Наслідки такого знеболювання щодо довгострокових результатів, таких як захворюваність, смертність і можливість прискорення відновлення в післяопераційному періоді, залишаються менш зрозумілими. Таким чином, як і раніше відсутні надійні дані про клінічний вплив регіональної анестезії за межами її добре відомих позитивних ефектів зменшення болю та скорочення споживання опіоїдів [7,9,10,12].…”