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Few studies have reported the beneficial effects in
patients treated with continuous regional anesthesia. Further extensive studies
with improved study design focusing on long-term patient-centered outcomes are
needed.
Regional anaesthesia is the use of local anaesthetics which further block sensations of pain from a specific large area of the body, like an arm or leg or the abdomen. Regional anaesthesia allows surgical procedures to be done on a region of the body without making anyone unconscious.
Regular use of regional anaesthesia for a surgical procedure in a patient for the prevention and treatment of acute pain is supported by general safety and proven effectiveness as a targeted modality.
At current time perioperative physicians are developing more interest to improve long-term outcomes after surgery, instead of focusing on the well-established short-term benefits of regional anaesthesia. Their interest has opened up important questions concerned with the potential influence of regional anaesthesia on morbidity and mortality, persistent pain and cancer prognosis. Inflammatory reaction and physiologic stress response are the results of tissue injury which has been observed during the perioperative period. These could affect a patient's recovery trajectory.
Regional anaesthesia can directly modify the inflammatory response by the anti-inflammatory effect of local anaesthetics, blocking neural afferents, and blunting sympathetic activation. Also, continuous techniques (e.g., epidural and perineural catheters) are capable of delivering longer duration and titratable pain relief in the perioperative period. They can even protect against the development of persistent post-surgical pain by providing effective acute pain management and reducing the exposure to opioids.
To enhance the effect of the potential for long-term outcome benefits to
surgical patients, continuous regional anaesthesia techniques are preferred
over single injection techniques. Although the data are not yet conclusive,
certain studies have evaluated better functional recovery after joint
replacement and lower rates of cancer recurrence in patients treated with
continuous regional anaesthesia. Future research studies in regional
anaesthesia will have to focus on these long-term patient-centered outcomes and
may need to incorporate novel study designs and analyses of big data.
Minerva Anestesiol. 2017 Jun 12
Continuous regional anesthesia: a review of perioperative outcome benefits
Bugada D et al.
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