Outcome after regional anesthesia: weighing risks and benefits

Regional anesthesia has become a widely used method to provide intraoperative anesthesia, and postoperative analgesia. This review seeks to address the question whether patient outcomes are improved to an extent that justifies using regional anesthesia as a routine method. During the past decade, a very critical appraisal of risks and benefits of regional anesthetic procedures has taken place. In general, the indications for epidural blockade have decreased, and are limited to individual high-risk patients, major upper abdominal and major vascular surgery, and thoracotomy. We review the changing role of central and peripheral regional anesthesia in the perioperative management of total knee arthroplasty. Immediate perioperative outcome after knee arthroplasty concerning function and pain is improved, and rehabilitation facilitated, by peripheral nerve blockade, but this does not translate into superior functional outcome one year later. A substantial share of the beneficial effects of regional anesthesia on the immune system, hemostasis, pain, and the duration of ileus can be duplicated using intravenous administration of local anesthetics. In general, the use of regional anesthesia should always be preceded by a weighing of potential risks and proven benefits. Regional anesthesia continues to play a major role in perioperative medicine, but its role keeps getting more defined and less non-committal.