Does regional anaesthesia improve outcome?

There is conclusive evidence that both central neuraxial techniques (spinal, epidural) and major peripheral nerve blocks can provide a quality of postoperative analgesia that is better than systemic or parenteral opioids. An improved quality of postoperative analgesia is a worthwhile humanitarian aim in its own right, but regional anaesthesia may also have the potential to improve the quality of outcome of surgery. Proving that regional anaesthesia can influence the outcome of surgery has been a difficult and challenging project for a number of years; many studies have been inconclusive with methodological weaknesses making comparison difficult and offering conflicting evidence. However, recently the weight of evidence from large systematic reviews suggests that regional anaesthesia can indeed improve outcome of surgery when incorporated into a structured postoperative rehabilitation and recovery programme. Effective analgesia alone will not markedly change surgical outcome. A postoperative lumbar epidural infusion will have no long-lasting benefits, once it is discontinued unless the quality of analgesia provided during the infusion is used to achieve specific targets. These targets include early mobilization, active physiotherapy and early return to enteral nutrition. Other benefits of regional anaesthesia (reduced blood loss, risk of thromboembolic events and duration of ileus) can also contribute to a reduction of the risks of postoperative morbidity. However, unless the postoperative recovery programme is modified to incorporate these benefits into a patient’s recovery, the full potential of regional anaesthesia’s contribution to surgical outcome will not be realized.