Implications of Regional Anaesthesia for Favourable Postoperative Outcomes

Vol 2 | Issue 1 | January-June 2021 | Page 13-16 | Abhijit Nair, Sandeep Diwan


Authors: Abhijit Nair [1, 2], Sandeep Diwan [3]

[1] Department of Anaesthesia, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana State, India.
[2] Department of Anaesthesiology, Ibra Hospital, North Sharqiya Governorate, Ibra-414, Sultanate of Oman.
[3] Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Abhijit Nair,
Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana State, India.
Ibra Hospital, North Sharqiya Governorate, Ibra-414, Sultanate of Oman.
E-mail: abhijitnair95@gmail.com


Introduction


Patient centered outcomes after surgery are described in terms of improving quality of life and functional status, prevent cognitive impairment, delirium, anxiety and depression and preserve organ function [1]. Regional anaesthesia (RA) when used solely or for postoperative analgesia with general anaesthesia (GA) indeed provides better quality of analgesia, lesser opioid consumption and lesser adverse events like postoperative nausea/vomiting (PONV) due to opioids, bleeding or renal toxicity (due to non-steroidal anti-inflammatory drugs). However, the benefits of RA are not just confined to providing opioid-sparing analgesia but many other important early and late postoperative outcomes which has established RA as an integral part of perioperative analgesia [2]. In this editorial, the term RA is used for central neuraxial blocks (spinal and epidural anaesthesia), the peripheral nerve blocks and the fascial plane blocks depending on the type of surgery and the purpose of RA i.e., surgical anaesthesia or postoperative pain relief.


References


1. Bowyer AJ, Royse CF. Postoperative recovery and outcomes–what are we measuring and for whom? Anaesthesia. 2016;71 Suppl 1:72-7.
2. Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? Br J Anaesth. 2011;107 Suppl 1: i90-5.
3. Small C, Laycock H. Acute postoperative pain management. Br J Surg. 2020 ;107: e70-e80.
4. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287-98.
5. Kessler J, Marhofer P, Hopkins PM, Hollmann MW. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth. 2015; 114:728-45.
6. Milosavljevic SB, Pavlovic AP, Trpkovic SV, Ilić AN, Sekulic AD. Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients. Med Sci Monit. 2014; 20:1833-40.
7. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016; 33:160-71.
8. Moon YE. Postoperative nausea and vomiting. Korean J Anesthesiol. 2014; 67:164-170.
9. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020; 131:411-48.
10. Li J, Zhu Y, Chen W, Zhao K, Zhang J, Meng H et al. Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study. J Orthop Surg Res. 2020; 15:605.
11. Wang H, Kandemir U, Liu P, Zhang H, Wang PF, Zhang BF, Shang K, Fu YH, Ke C, Zhuang Y, Wei X, Li Z, Zhang K. Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures. Injury. 2018; 49:1353-7.
12. Smith LM, Cozowicz C, Uda Y, Memtsoudis SG, Barrington MJ. Neuraxial and Combined Neuraxial/General Anesthesia Compared to General Anesthesia for Major Truncal and Lower Limb Surgery: A Systematic Review and Meta-analysis. Anesth Analg. 2017; 125:1931-45.
13. Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, Murad MH, Mantilla CB. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth. 2016; 116:163-76.
14. Pozek JP, Beausang D, Baratta JL, Viscusi ER. The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented? Med Clin North Am. 2016; 100:17-30.
15. Ahuja V, Thapa D, Ghai B. Strategies for prevention of lower limb post-amputation pain: A clinical narrative review. J Anaesthesiol Clin Pharmacol. 2018; 34:439-49.
16. Wang W, Wang Y, Wu H, et al. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Med Sci Monit. 2014; 20:1908-12.
17. Kotekar N, Kuruvilla CS, Murthy V. Post-operative cognitive dysfunction in the elderly: A prospective clinical study. Indian J Anaesth. 2014; 58:263-8.
18. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22 Suppl 3:67-79.
19. Davis N, Lee M, Lin AY, et al. Postoperative cognitive function following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol. 2014; 26:369-76.
20. Zywiel MG, Prabhu A, Perruccio AV, Gandhi R. The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res. 2014; 472:1453-66.
21. Nair AS, Naik V, Saifuddin MS, Narayanan H, Rayani BK. Regional anesthesia prevents cancer recurrence after oncosurgery! What is wrong with the hypothesis? Indian J Cancer 2020; XX: XX-XX. 10.4103/ijc.IJC_331_20 (Accepted manuscript)
22. Divatia JV, Ambulkar R. Anesthesia and cancer recurrence: What is the evidence? J Anaesthesiol Clin Pharmacol 2014; 30:147–50.
23. Yap A, Lopez‑Olivo MA, Dubowitz J, Hiller J, Riedel B. Global Onco‑Anesthesia Research Collaboration Group. Anesthetic technique and cancer outcomes: A meta‑analysis of total intravenous versus volatile anesthesia. Can J Anaesth 2019; 66:546‑61.
24. Sessler DI, Pei L, Huang Y, Fleischmann E, Marhofer P, Kurz A et al; Breast Cancer Recurrence Collaboration. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet. 2019;394(10211):1807-15.
25. Neal JM. Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis. Reg Anesth Pain Med. 2016; 41:195-204.
26. Topor B, Oldman M, Nicholls B. Best practices for safety and quality in peripheral regional anaesthesia. BJA Educ. 2020; 20:341-7.
27. Shivaprakash S, Diwan SM | Anatomy of Brachial Plexus Above The Clavicle |International Journal of Regional Anaesthesia | January-June 2021; 2(1): 29-34.
28. Sivashanmugam | Volume of Local Anaesthetic Agents and Block Efficacy in Blocks Above the Clavicle |International Journal of Regional Anaesthesia | January-June 2021; 2(1): 35-38.
29. Mirle R, Mukundan S | Cadaveric Workshop and Implications in Regional Anaesthesia | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 22-28.
30. Gopal TVS, Amjad Maniar A, Chakraborty A, Kulkarni R | Abdominal WallBlocks in Abdominal Surgery: An Update | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 47-53.
31. Sethi D, Nair A, Chhabra A | Regional Anaesthesia for Breast surgery |International Journal of Regional Anaesthesia | January-June 2021; (1): 40-46.
32. Giri S | Landmark and PNS Guided Forearm Blocks | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 67-71.
33. Murlitondebhavi | IAORA4U– A Regional Anaesthesia App for AORA Members | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 72-73.
34. Ponde V | Sterility Protocols During Regional Anaesthesia |International Journal of Regional Anaesthesia | January-June 2021; 2(1): 05-12.
35. Grewal A | Case Report: Pearls and Pitfalls | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 09-21.


How to Cite this Article: Nair A, Diwan S | Implications of Regional Anaesthesia for Favourable Postoperative Outcomes | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 13-16.


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