Tuesday, 26 May 2015

Peripheral regional anaesthesia and outcome: Lessons learned from the last 10 years. BJA February 2015.

This is a narrative review looking at the published data on efficacy and safety of the most common upper limb, lower limb and trunk peripheral nerve blocks over the last 10 years.

The paper sets out to collate all recent studies on the short and long term risks and benefits of regional blocks when compared to GA alone. This is a narrative review rather than a systematic review so there is no meta-analysis. The justification for this is the heterogeneity in techniques and outcome measures.

The description of improved outcome measures are pretty vague because they haven’t tried to collate the data from the RCTs but it is still a useful summary and helpful in terms of providing information for your patients when discussing risks and benefits for particular blocks. Also a good source of references for block related RCTs.

Notable points include:

  • Significant improvement in early recovery, opiate use, patient satisfaction and PONV for all regional techniques.
  • No recent publications supporting longer term benefits (day 14 onwards)
  • Higher than anticipated rated of neurological complications from axillary blocks
  • Improved recovery and post-op opiate use following TAP blocks for patients undergoing simple day surgery laparoscopic procedures.

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