J Kessler1, P Marhofer2, P M Hopkins3, M W Hollmann4. 1. Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany. 2. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria peter.marhofer@meduniwien.ac.at. 3. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. 4. Department of Anaesthesiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Our aim was to review the recent evidence for the efficacy of peripheral regional anaesthesia. METHODS: Following a systematic literature search and selection of publications based on prospectively agreed upon criteria, we produced a narrative review of the most commonly performed peripheral regional anaesthetic blocks for surgery on the upper limb, the lower limb, and the trunk. We considered short-term and longer-term benefits and complications among the outcomes of interest. RESULTS: Where good quality evidence exists, the great majority of the blocks reviewed were associated with one or any combination of reduced postoperative pain, reduced opioid consumption, or increased patient satisfaction. For selected surgical procedures, the use of blocks avoided general anaesthesia and was associated with increased efficiency of the surgical pathway. The exceptions were supraclavicular block, where there was insufficient evidence, and transversus abdominis plane block, where the evidence for efficacy was conflicting. The evidence for the impact of the blocks on longer-term outcomes was, in general, inadequate to inform clinical decision making. Permanent complications are rare. CONCLUSIONS: The majority of peripheral regional anaesthetic techniques have been shown to produce benefits for patients and hospital efficiency. Further interventional trials are required to clarify such benefits for supraclavicular block and transversus abdominis plane block and to ascertain any longer-term benefits for almost all of the blocks reviewed. Permanent complications of peripheral regional anaesthetic blocks are rare but accurate estimates of their incidence are yet to be determined.
BACKGROUND: Our aim was to review the recent evidence for the efficacy of peripheral regional anaesthesia. METHODS: Following a systematic literature search and selection of publications based on prospectively agreed upon criteria, we produced a narrative review of the most commonly performed peripheral regional anaesthetic blocks for surgery on the upper limb, the lower limb, and the trunk. We considered short-term and longer-term benefits and complications among the outcomes of interest. RESULTS: Where good quality evidence exists, the great majority of the blocks reviewed were associated with one or any combination of reduced postoperative pain, reduced opioid consumption, or increased patient satisfaction. For selected surgical procedures, the use of blocks avoided general anaesthesia and was associated with increased efficiency of the surgical pathway. The exceptions were supraclavicular block, where there was insufficient evidence, and transversus abdominis plane block, where the evidence for efficacy was conflicting. The evidence for the impact of the blocks on longer-term outcomes was, in general, inadequate to inform clinical decision making. Permanent complications are rare. CONCLUSIONS: The majority of peripheral regional anaesthetic techniques have been shown to produce benefits for patients and hospital efficiency. Further interventional trials are required to clarify such benefits for supraclavicular block and transversus abdominis plane block and to ascertain any longer-term benefits for almost all of the blocks reviewed. Permanent complications of peripheral regional anaesthetic blocks are rare but accurate estimates of their incidence are yet to be determined.
Authors: Pierluigi Giampaolino; Luigi Della Corte; Antonio Mercorio; Dario Bruzzese; Antonio Coviello; Giovanna Grasso; Anna Claudia Del Piano; Giuseppe Bifulco Journal: Updates Surg Date: 2022-06-27
Authors: Stephanie Lam; Helena Qu; Margaret Hannum; Kay See Tan; Anoushka Afonso; Hanae K Tokita; Patrick J McCormick Journal: Anesth Analg Date: 2021-07-01 Impact factor: 6.627
Authors: Mark Verlinde; Markus W Hollmann; Markus F Stevens; Henning Hermanns; Robert Werdehausen; Philipp Lirk Journal: Int J Mol Sci Date: 2016-03-04 Impact factor: 5.923