Regional Anesthesia

For instance, a Chinese metaanalysis investigated 21 randomized clinical trials comparing RA vs. GA in hip- or knee arthroplasty. The pooled results of these trials showed that RA reduced surgery time (Odds Ratio [OR] -0.12 in favor of RA), need for blood transfusion (OR -0,48) and incidence of a thromboembolic event (deep vein thrombosis OR 0,45; pulmonary embolism 0.48). The authors’ summary: regional anesthesia seems to improve outcomes of patients after hip- or knee arthroplasty vs. general anesthesia (1). Reminder: An OR < 1 indicates that the group (in this case RA-patients) has a smaller probability to experience the investigated event.

Another study investigating the effects of RA vs. GA in total hip arthroplasty included 13,000 patients, 40 percent of which received RA. While RA patients did not show a significantly reduced mortality rate, they did have a significantly lower risk of postoperative wound infection (OR 0.38), a (slightly) shorter length of hospital stay (5%) and a 27 percent lower risk of prolonged hospitalization, compared to GA-patients. In addition, RA-patients had a lower risk of cardiovascular and respiratory complications (OR 0.61 and 0.51, respectively). According to the US-American authors, these results should be considered in all health care systems – from a medical, but also from an economic point of view. 

Three surgeons at the University of Michigan focused on postoperative complications in patients with chronic-obstructive lung disease (COPD) who underwent surgery ³. The authors compared the morbidity of 2,644 patients undergoing RA (spinal, epidural or peripheral nerve block) vs. 2,644 patients under general anesthesia. Compared to RA-patients, GA-patients had a higher incidence of postoperative pneumonia (3.3 vs. 2.3%), prolonged ventilator dependence (2.1 vs. 0.9%) and unplanned postoperative intubation (2.6 vs. 1.8%). The composite morbidity was 15.4 percent in the GA group vs. 12.6 percent in RA-patients.

And: According to a Cochrane Review, the administration of spinal rather than general anesthesia may reduce the risk of postoperative apnea by up to 47 percent in preterm infants undergoing inguinal herniorraphy ⁴.

The advantages of regional anesthesia were also addressed at “Euroanaesthesia” congress, which took place in Geneva at the beginning of June 2017. One expert’s lecture on orthopedic interventions referred to the following study results:

• For ambulatory upper and lower extremity surgery, regional anesthesia techniques have been shown to be effective in reducing complications leading to readmissions ⁷
• Additionally, the standard of care for postoperative pain control at home (sciatic nerve block using an elastomeric pump delivering ropivacaine 0.2% 5 ml/h) was not worse than in-hospital analgesia regimes, but associated with lower costs: 8,000 euros less per patient. Moreover, unplanned visits and readmissions were lower compared to inpatient treatment ⁸.

The lecturer, anesthetist Dr. Jose Aguirre of the Balgrist University Hospital in Zurich, concluded that regional anesthesia is associated with “major advantages” concerning postoperative pain, complications needing readmissions and costs. Moreover, an ageing population with a higher level of morbidity would require anesthesia regimens with low impact on cardiac and respiratory function. This, says the expert, will translate into „reduced direct and indirect costs.” ⁹.