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Chapter 67. The Effects of Regional Anesthesia on Functional Outcome After Surgery

Which of the following is true of chronic pain after surgery?

A. After thoracotomy or limb amputation, 40% of patients suffer from persistent pain.

B. After cesarean delivery, 25% of patients develop persistent pain.

C. Risk of chronic pain after inguinal hernia surgery is about 33%.

D. Chronic pain is defined as pain beyond 8 months.

A is correct. Post-thoracotomy pain and phantom limb pain still occur frequently despite multimodal analgesic techniques.1,2

Which of the following is true regarding regional anesthesia after major joint replacement surgery?

A. Short-term gains in function are usually sustained in the long run.

B. Early mobilization is helpful but not a central part of long-term joint function.

C. Gains in passive joint range of motion due to regional anesthesia last for several months after surgery.

D. Anesthesia that lasts more than 24 hours worsens outcome due to stretch injury.

C is correct. Regional anesthesia for joint replacement allows for better joint flexibility. It could be due to improved rehabilitation, lower pain scores, or better operating conditions.3,4

Regional anesthesia may impact postoperative cognitive dysfunction (POCD). Which of the following statements is true about POCD?

A. It independently predicts adverse outcomes but not mortality increases.

B. It independently predicts long-term cognitive impairment.

C. It is associated with similar health care costs compared to patients without it.

D. Morbidity increases but mortality does not.

B is correct. POCD is very debilitating and is a risk factor for long-term cognitive deterioration.5

Research papers comparing regional versus general anesthesia for postoperative cognitive dysfunction (POCD) have limitations and show what findings?

A. Long-term cognitive function was not significantly different.

B. Midazolam does not have affects on POCD.

C. Short-term cognitive impairment was similar in both groups.

D. Regional benefits on POCD depend the most on gender.

A is correct. Evidence is weak when examining regional anesthesia and POCD. Current evidence does not find a ...

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