Regional anaesthesia and immunology

Numerous biological and physiological processes, such as the induction of inflammation, influence the patient's homoeostasis perioperatively, impairing immune function and increasing the postoperative risk of infection. In addition to the classic pharmacological effects of regional anaesthesia, such as analgesia and sympatholysis, there are other potentially immunologically significant effects of regional anaesthesia and the local anaesthetics used on immune function. There is a great deal of positive experimental evidence for improved immunocompetence through perioperative regional anaesthesia. The effects on clini cally relevant endpoints are still unclear, mainly due to the lack of clinical data from randomised controlled trials. Current clinical studies provide some clues, but they are not evidence -based and thus not applicable to clarify the specific immunological effects of regional anaesthesia perioperatively and develop patient- and disease -specific strategies needed to optimise short- and long-term surgical outcomes. However, the advantages of central and peripheral regional anaesthesia, such as ensuring optimal analgesia and the potential reduction of complications, leave no doubt as to its clinical value. It remains to be seen whether a more differentiated application, e.g., in the case of a high perioperative risk or in ERAS- concepts, will lead to a reduction in immunologically induced complications or positive synergies in oncological collectives.