Does regional anaesthesia improve outcome?

There is conclusive evidence that regional anaesthesia techniques provide a quality of postoperative analgesia that is better than systemic opioid techniques. Continuous, effective postoperative analgesia is a worthwhile humanitarian aim in its own right, but regional anaesthesia also has the potential to improve the functional outcome from surgery. Proving that regional anaesthesia can influence the outcome of surgery is challenging; many studies are inconclusive with methodological weaknesses making comparison difficult and offering conflicting evidence. Large systematic reviews offer better evidence that regional anaesthesia improves outcome but effective analgesia alone will not markedly change surgical outcome. A postoperative lumbar epidural infusion will have no long-lasting benefits, once it is discontinued. Regional anaesthesia improves outcome most effectively only when incorporated into a structured postoperative rehabilitation and recovery programme, using the effective analgesia provided to achieve specific targets. These targets include early mobilization, active physiotherapy and early return to enteral nutrition. Other benefits of regional anaesthesia (reduced blood loss, lower risk of thromboembolic events and duration of ileus) can also contribute to a reduction in postoperative morbidity. However, unless the postoperative recovery programme is modified to incorporate these benefits into a patient's recovery, the full potential of regional anaesthesia's contribution to surgical outcome will not be realized.