Regional analgesia and orthopaedic surgery

Regional Anaesthesia and Analgesia is a growing subspecialty, which impacts on all orthopaedic procedures. Advances continue to be made in the range of techniques available to the anaesthetist, which will influence patient outcomes. It is therefore essential that all practicing orthopaedic surgeons understand the background principles and practices of regional anaesthesia to aid in treatment planning and team decision making. All regional procedures have the potential to facilitate postoperative recovery, however all have inherent risks and if “overdone” may inhibit early rehabilitation. Only with a proper understanding of the techniques available can an informed choice be made by the patient and surgeon.This review examines the pharmacology of current local anaesthetics and additives, the pros and cons of central axial blocks and differing techniques including Local Infiltration Arthroplasty (LIA) and ultrasound guided blocks for major joint surgery in the upper and lower limbs. It is not intended as a literature review of all the latest esoteric techniques but as a background essential reading of what is currently happening in regional anaesthesia.