[Regional anaesthesia versus general anaesthesia--pathophysiology and clinical implications]

Regional anaesthesia is well established in modern clinical practice. It provides a safe and reliable alternative to general anaesthesia, but is also of high clinical value in combination procedures. Our knowledge of perioperative pathophysiological characteristics increasingly indicates that regional blocks lead to excellent analgesia und profoundly modulate the postoperative stress response and thus, they can have therapeutic influence on postoperative convalescence, on the functional operation result and on the avoidance of frequent postoperative complications. Given the increasing number of older patients with nigher co-morbidity, this is of particular therapeutic importance, but also has economic implications. The continuous techniques of regional anaesthesia, which at first sight are more time-consuming and expensive, may shorten the time to extubation after major abdominal procedures, accelerate postoperative recovery and prevent postoperative adverse outcomes. Optimised physiotherapy after total knee arthroplasty or improvements in pulmonary and gastrointestinal function demonstrate the capabilities of regional anaesthesia to facilitate postoperative rehabilitation. With regard to an improved organ function and a possibly shorter hospital stay, regional techniques appear cost-effective. It is important that regional anaesthesia is carried out on the basis of a clear individual indication, which considers the entire perioperative treatment process.