Regional Anesthesia Delivers Benefits

From Clinical Update, Spring 2005

Abstract: Blocking pain at the source, regional anesthesia delivers improved postoperative pain relief, faster recovery, and fewer side effects and postoperative risks.

Adverse effects are expected when general  anesthesia is administered, the most common being nausea, vomiting, sore throat and sleepiness. However, these side effects can be avoided with the use of regional anesthesia.

Regional anesthesia is different from general anesthesia because pain is blocked at the source. Some proven clinical advantages of choosing regional anesthesia as part of anesthetic management include better postoperative pain relief, less narcotic use, faster recovery, less nausea, and for some surgeries, less blood loss and less risk of blood clots.

“Modern literature supports regional anesthesia in the average, healthy patient in order to optimize recovery—in terms of rapidity and ease at which the patient returns to their pre-operative condition,” says J.C. Gerancher, M.D., section head for Regional Anesthesia and Acute Pain Management at Wake Forest University Baptist Medical Center.

There are several types of regional anesthesia being used at Wake Forest Baptist, including peripheral nerve blocks, epidurals and spinals. Anesthesiologists here can also send the patient home after surgery with disposable pumps to self-administer pain-relieving anesthesia for up to approximately two weeks.

Wake Forest Baptist has one of the nation’s leading resident training programs in peripheral nerve blockade, particularly with continuous catheter techniques. A visiting preceptorship for clinicians who have completed their training has also been initiated.

Gerancher says the advantage of regional anesthesia goes beyond the patient.

“Because regional anesthesia can be induced prior to the arrival of the patient in the operating room, operating room efficiency can be increased with a consistent approach to regional anesthesia. The time-savings in waking patients from sedation rather than emergence from general anesthesia at the end of surgery, and less time and effort expended in the recovery room are important added benefits in efficiency for surgeons, nurses, anesthesia providers and hospitals.”

Another distinction between regional and general anesthesia occurs on the neurohumeral level while the patient is asleep.

“Although a patient may appear asleep during both regional anesthesia with sedation and during general anesthesia, a whirlwind of neurophysiologic responses are occurring in the patient who has general anesthesia,” Gerancher said.

When the type of surgery will allow it, regional anesthesia blocks these neurophysiologic responses, all of which are detrimental to the patient. The so-called ‘fight or flight’ stress responses to surgery under general anesthesia (cathecholamine release, ileus, increased blood clotting, fluid retention, protein catabolism, and interference with immune function) have all been shown to be minimized when regional anesthetic techniques are used instead of general anesthesia alone.

Gerancher says that patients know and experience the difference first-hand.

“The most rewarding feedback has been from patients who have repeat surgeries and try regional anesthesia for the first time. They are the patients who initially are the most skeptical but wind up being the best advocates for having regional anesthesia for routine surgery.”