FRCA Notes


Advantages & Disadvantages of Regional Anaesthesia

The curriculum asks for knowledge of 'the advantages/disadvantages, risks/benefits and indications/contra-indications of regional blockade'

Resources


Patient benefits

  • Avoids GA and its sequelae including:
    • Cardiovascular compromise
    • PONV
  • Attenuates stress response to surgery e.g. improved glycaemic control, reduced myocardial ischaemia

  • Analgesia:
    • Superior post-operative analgesia to parenteral opioids
    • Reduces use of, and side-effects from, alternative analgesics e.g. opioids
    • Reduced incidence of chronic post-surgical pain e.g. post-thoracotomy pain

  • Less immunosuppressive compared to GA or opioids
  • Potentially reduced sleep disturbance
  • Higher patient satisfaction

Surgical benefits

  • Facilitates earlier physiotherapy and joint mobilisation after lower limb arthroplasty
  • Longer-lasting patency of AV fistulae in those created under RA vs. local anaesthesia

Institutional benefits

  • Reduced length of stay
  • Reduced rate of unanticipated day surgery admission
  • Reduced odds of unplanned ICU admission vs. GA alone in patients undergoing major truncal or limb surgery
  • Possible reduction in healthcare costs


Disadvantages of major limb blocks
Requires appropriate equipment and specialist training
Requires time to perform the block
Patient discomfort during procedure
Finite duration if single-shot technique used
Rebound pain if single-shot technique used
Prolonged motor block and risk of falls
Risk of complications including block failure and need for alternative anaesthesia/analgesia



Respiratory Cardiovascular Gastrointestinal Metabolic Haematological
↑ FVC at 24hrs Possible ↓ incidence of post-operative MI Earlier return of GI motility ↓ catecholamines ↓ incidence of VTE
↑ FRC / reduced atelectasis ↓ incidence of post-operative HF Earlier return of enteral feeding ↓ cortisol Improved surgical graft function
↓ risk of pneumonia (39%) ↑ splanchnic blood flow Better glycaemic control ↓ blood loss
↓ opioid-induced respiratory depression
  • Overall reduced mortality