Anesthesia Articles
REGIONAL ANESTHESIA FOR POSTOPERATIVE PAIN CONTROL
from: www.emedicine.medscape.com
In many centers, regional anesthesia techniques are used extensively to allow the performance of orthopedic procedures. The intraoperative use of regional anesthesia has many advantages, including the following:
Advantages of intraoperative use of regional anesthesia
- Reduces blood loss: In total hip arthroplasty (THA), studies have demonstrated that both spinal and epidural anesthesia tend to have approximately a 30% reduction in intraoperative blood loss compared with general anesthesia due to lower arterial and venous pressures.
- Reduces rates of deep venous thrombosis (DVT): Epidural and spinal anesthesia both reduce DVT risk by improving blood flow through the legs secondary to sympathectomy-induced vasodilatation; both anesthesia methods may also reduce perioperative hypercoagulability that occurs as a result of the surgical stress response.
- Avoids common adverse effects of general anesthesia: Such adverse effects include nausea, sore throat, alteration of mental status, and cognitive dysfunction.
- Allows patient involvement: Some patients enjoy the ability to watch knee arthroscopic procedures on the video monitor.
- Improves pain control: Regional techniques can block or reduce pain anywhere from several hours to several days, depending on the technique that is used. Preemptive pain management may reduce subsequent pain in the days to weeks following surgery. Greater pain control has the potential to allow for earlier hospital discharge and may improve the patient's ability to tolerate physical therapy.
Various regional analgesia techniques exist that can be used to promote postoperative pain relief. These methods can be categorized into neuraxial local analgesics and narcotics, peripheral nerve blocks, and wound infiltration.