Applications and controversies of combination regional blockage withgeneral anesthesia for surgical procedure

Abstract

Background The combination of regional block with general anesthesia for major surgery and postoperative analgesia during perioperative period has recently become increasingly popular. Although there is good evidence that regional technique offers superior pain relief to systemic opioid analgesia, whether the combination regional block with general anesthesia could improve the overall outcomes after surgery remains elusive. Objective The aim of this review was to evaluates the effects of regional anaesthesia on middle and long-term postoperative outcomes, and the risks and controversies applied for surgical procedure.Content The majority of evidence favors an ability of epidural block to reduce postoperative cardiovascular and pulmonary complications after major vascular surgery or in high-risk patients. Although rehabilitation in the immediate postoperative period is possibly improved for regional block, the advantages in the long term remain unclear. Preliminary data suggest that regional blockage might reduce the incidence of cancer recurrence and prevent the development of chronic postoperative pain. Permanent neurological damage is extremely rare. However, the hypothesis that regional anesthesia might have a beneficial effect on patient outcome from surgery remains difficult to prove, despite some early evidence in its favor, and the benefit of regional block has also decreased because of rapid conversion of major surgery to minimally invasive techniques that carry less risk of complications. Trend Perioperative regional block techniques may provide improvement in middle and long-term postoperative outcomes. Although the benefit appears to be limited, considering the importance of the outcomes of interest, even minor improvement probably has substantial clinical relevance. The perioperative regional anesthetic techniques need to be weighed any potential benefits and risks based on individual assessment. Key words: Regional anesthesia and analgesia; Outcome; Risk; Controversy