Regional anaesthesia and perioperative outcome

The ongoing debate on the outcome benefits of regional anaesthesia and analgesia over general anaesthesia and systemic analgesia has led to a large number of recently published papers, in particular systematic reviews and meta-analyses that justify a review of the current status of the debate.

Meta-analyses have shown consistently improved analgesia with epidural techniques, but the results are by far less consistent with regard to other outcomes, in particular morbidity and mortality. Specific outcomes in specific types of surgery, however, such as bowel recovery after abdominal surgery, can be improved by neuraxial blockade, which also remains the technique of choice for obstetric analgesia and anaesthesia. In certain indications, peripheral nerve blocks may have the potential to replace neuraxial blocks while maintaining the benefits of the regional technique, such as paravertebral blocks for thoracotomies.

Although there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anaesthesia on outcome is not completely resolved, possibly because the data are often not procedure specific. In addition, however, it may be that our current literature cannot provide a definitive answer.