Regional anesthesia and perioperative outcome: what is new?

Abstract

Despite the controversies, the numerous potential benefits and advantages of regional anesthesia are keys to its continued popularity. With constant search for new scientific clues by improving experimental designs, valuable evidence slowly unfolds. Regional anesthesia certainly takes a leading role in the current trends for a multimodal approach of perioperative pain management.

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

“…TEA has been associated with earlier mobilization, reduced opioid consumption, and improved cough, and thus, it has beneficial effects on lung functions causing diminished incidences of atelectasis or pneumonia [15,24]. In another meta-analysis including only CABG, patients reported faster extubation and less pulmonary complications with thoracic epidural blockade [23].…”

“…In our study, we showed that TEA causes reduced incidence of atelectasis in comparison to LEA. No permanent neurological sequelae were reported in a total of 4,185 patients with use of TEA; however, temporary neurological sequelae such as peripheral nerve injury or dural tap-related headache are much more frequent [24]. …”

Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery

“…However, the debate whether epidural analgesia improves outcome has not been settled. 11 For colorectal surgery, epidural analgesia decreased postoperative pain and ileus rate, with no effects on hospital stay. 12 In patients undergoing abdominal aortic operations, epidural anesthesia and analgesia improved overall outcome and decreased intubation time and ICU stay.…”

“…Epidural analgesia has become a popular analgesic technique for abdominal surgery with high efficacy and safety. However, the debate whether epidural analgesia improves outcome has not been settled . For colorectal surgery, epidural analgesia decreased postoperative pain and ileus rate, with no effects on hospital stay .…”

The Potential Role of Regional Anesthesia in Perioperative Anti-Inflammatory Treatments

“…Several published manuscripts in recent years on the potential non-analgesic applications of regional anesthesia encourage us to expand its role from intraoperative to the perioperative period. However, its clinical advantages are not fully disclosed and even its overall beneficial effect on patient outcome is still controversial (1).…”