Which patients benefit from regional anaesthesia?

The aim of the review is to examine the possible benefit of regional anaesthesia in four areas of perioperative care. These are: the relationship between anaesthesia and cancer recurrence; the effects of regional anaesthesia in orthopaedic surgery; its use in people with obstructive sleep apnoea syndrome; and its potential for preventing chronic postsurgical pain.

There are a number of studies of different designs attempting to shed light on these topics. These range from animal work, through observational studies including analyses of administrative databases, to randomized controlled trials, and systematic reviews. One methodological difficulty within clinical investigations is to fully distinguish patients who have received regional anaesthesia from those who have received general anaesthesia, as many receive regional anaesthesia with sedation and this is not always separately noted, nor the degree of sedation recorded. This continues to make interpretation difficult.

There is at present little unequivocal, high-quality evidence to confirm clear superiority of regional anaesthesia over general anaesthesia for any of the conditions described in this article. Perhaps as important as the choice of technique is the practitioner's skill and attention to detail; in addition, the major contributor to perioperative risk remains the patient and his/her pre-existing condition.