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Regional techniques and outcome: what is the evidence?

Hanna, Marie N; Murphy, Jamie D; Kumar, Kanupriya; Wu, Christopher L

Current Opinion in Anesthesiology: October 2009 - Volume 22 - Issue 5 - p 672–677
doi: 10.1097/ACO.0b013e32832f330a
Regional anaesthesia: Edited by Bernadette Veering

Purpose of review Despite some controversy regarding the strength of the available data, the use of regional anesthesia and analgesia does provide improvement in patient outcomes. Although the majority of available data have examined the effect of epidural anesthesia and analgesia on patient outcomes, an increasing number of studies recently have investigated the effect of peripheral regional techniques on patient outcomes.

Recent findings Data generally indicate that the perioperative use of regional anesthesia and analgesia may be associated with improvement in both major (e.g. mortality, major morbidity) outcomes and rehabilitation. The majority of evidence favors an ability of epidural analgesia to reduce postoperative cardiovascular and pulmonary complications and there is also consistent evidence that epidural analgesia with local anesthetics is associated with faster resolution of postoperative ileus after major abdominal surgery. Overall, regional analgesic techniques provide statistically superior analgesia compared with systemic opioids.

Summary Perioperative use of regional analgesic techniques may provide improvement in conventional outcomes, although the benefit appears to be limited to high-risk patients and those undergoing high-risk procedures. The benefits conferred by perioperative regional anesthetic techniques need to be weighed against any potential risks and this should be assessed on an individual basis.

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA

Correspondence to Christopher L. Wu, MD, The Johns Hopkins Hospital, Carnegie 280, 600 North Wolfe Street, Baltimore, MD 21287, USA Tel: +1 410 614 0401; fax: +1 410 614 1796; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.