Future of regional anaesthesia and pain management

Consideration of the future practice of regional anaesthesia and pain management must include more than scientific advances. With advances in technology, the practice of medicine will increasingly become international in scope. Socio-economic issues will also have increasing impact on the practice of regional anaesthesia and pain management. More attention will be given to improved outcome and reduced morbidity as addressed by the "closed claims study" of the American Society of Anesthesiologists. Advances in the practice of spinal and epidural anaesthesia will come through improved understanding of nociceptive conduction and receptor physiology. New drugs will focus on specific neural function so that motor, sensory and autonomic blockade may be invoked and antagonized as clinical circumstances require. Advances in peripheral neural blockade will focus on drugs that can provide markedly prolonged effects in the range of days to weeks. Alternate approaches will be the development of neural specific lytic agents that will not spread to or damage surrounding tissues.