Regional blockade versus analgesic therapy

Like other investigators, we have found that the postoperative period is characterized by high energy expenditure, pain, high plasma catecholamines and decreased arterial oxygen tension, and also glycogenolysis, lipolysis, proteolysis and a low turn-over rate of glucose. Regional anaesthesia has often been supposed to counteract some of these phenomena without causing ventilatory depression. During the past few years a number of studies have been carried out in our department with the aim of elucidating possible differences between the effects of systemic analgesics and different regional anaesthetic blockades. Thus, we have found that both systemic analgesics and regional anaesthesia decrease the total postoperative energy expenditure. Adequately administered regional anaesthesia and systemic analgesic therapy both relieve postoperative pain, the former without interfering with normal ventilatory function. In addition, regional anaesthetic techniques cause less mental confusion, fewer bowel problems and possibly less postoperative lung complications. Moreover, high spinal blockades seem to be the only means of reducing the post-traumatic metabolic stress reaction.