The focus of anesthesiologists on patient safety has led to advancements in anesthetic techniques and perioperative pain management, as well as profoundly affected patient care in the entire perioperative period. However, studies of the contributions of anesthesia and advances in analgesic approaches as well as their effects on measurable outcomes have only recently gained momentum and widespread recognition. The increasing realization that anesthesia-related factors and choices made by anesthesiologists can influence perioperative events and patient safety has thus sparked interest in a variety of outcomes previously thought beyond our control.
As the patient population seeking surgical care presents with serious comorbidity more commonly, the perioperative challenges will demand that anesthetic considerations assumes a major part of the care plan for patients to ensure the best possible outcomes. Utilizing regional anesthesia provides a significant benefit in achieving this goal.
In the past, the scope of neuraxial anesthesia and peripheral nerve blocks has primarily encompassed their use for intraoperative anesthesia and postoperative analgesia, respectively. However, the choice of anesthesia may positively influence the risk of perioperative cardiopulmonary complications, infections, and mortality.1,2 The pathophysiologic reasons for these findings remain incompletely understood. Attempts to explain these associations depend on a number of observations made in small clinical or preclinical studies. The effects seen, however, might feasibly represent a composite result of avoidance of general anesthesia on the one hand and intrinsic positive effects brought about by regional anesthesia on the other hand. General anesthesia, systemic analgesia, and mechanical ventilation often prove problematic in patients with comorbidity,3 especially those with pulmonary pathologies. Regarding the latter, neuraxial anesthesia was associated with lower blood loss, shorter surgical time, and a lower incidence of thromboembolism,4,5 possibly conferred by its sympatholytic action and beneficial effects on the coagulation system.6 In orthopedic patients, earlier mobilization and discharge readiness may contribute to a lower complication incidence. Advances in perioperative pain control have also been associated with better medical and economic outcomes as well as improved patient satisfaction.7,8 Moreover, recent research suggested that regional anesthesia may have long-term outcome benefits from reduction of cancer recurrence and prevention of chronic post-surgical pain.
However, there is little quantitative evidence on these beneficial effects of regional anesthesia, particularly for peripheral nerve blocks. Available studies are mostly limited by their small sample sizes and scope. Nonetheless, data gained from large-scale, population-based studies show promising results.
This chapter summarizes currently available data on outcomes pertaining to the use of regional anesthesia. The discussion focuses on its use in the context of specific surgical interventions. Regional anesthetic techniques and their impact on perioperative outcomes in selected types of surgeries, long-term medical outcomes, and finally economic outcomes and cost-effectiveness issues are reviewed.
SHORT-TERM OUTCOME: MORBIDITY AND MORTALITY
With the advent of advanced preoperative evaluation, perioperative monitoring, and treatment modalities, ...