Regional anesthesia and the perioperative period: basis and principles

Insufficient analgesia and/or opioid-related side effects may hinder the course of the postoperative recovery. Regional anesthesia and/or analgesia (RA) has the ability to provide optimal pain relief with a concomitant reduction of opiate consumption and its side effects. Some other potential advantages of RA have been described, such as the potential to reduce the surgical stress, or the prevention of chronic postoperative pain, which may represent significant benefits and strongly argues for a widespread use of RA.Locoregional techniques should be considered according to the type of the surgery. As surgery is moving toward minimally-invasive procedures, RA is making a clear shift toward more selective blockades and better tolerated techniques. Because central neuraxial blockade is associated with side-effects, peripheral nerve block or local infiltration should be preferred in certain indications. Recent development in ultrasound nerve localization may increase the number of patients who can benefit from RA and improve the success rate and thereby the acceptance of RA.In order to take full advantage of RA, it is necessary to implement postoperative care policy and procedures. They should include the use of RA concomitantly with patient information, the implementation of postoperative rehabilitation pathways in order to maximize its interest, education and training for healthcare providers, evaluation of practices and monitoring of patients outcomes.