The role of regional anaesthesia in patient outcome: thoracic and abdominal surgeries

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This review focuses on the establishment and implementation of well-defined, evidence-based clinical pathways in thoracic and abdominal surgeries, to facilitate improved outcomes and avoid complications, enabling rapid recognition and treatment of complications. Ultimately, this will facilitate the recovery process and return to baseline activity. Patients scheduled for either thoracic or abdominal surgery often have compromised cardiopulmonary and metabolic functions before surgery, and the procedure itself may decrease patients' reserve. Postoperative pain acts as an additional insult to body reserve, and regional anesthesia can be the most efficient technique to attenuate this. The greatest postoperative challenge for anesthetists is to attenuate the stress response and pain sufficiently so that functions are not compromised even further. Even the best postoperative regional analgesic techniques require a smooth and timely transition to oral multimodal pain strategies to maximize their benefits.

Section snippets

Thoracic surgery

Thoracic surgery patients have compromised pulmonary function before surgery, and the surgery itself may decrease total lung capacity, forced expiratory volume, and forced vital capacity further as a consequence of resection. Postoperative pain acts as a further insult to pulmonary function by limiting the degree and frequency of chest wall expansion.1 The greatest postoperative challenge for anesthetists during this procedure is to attenuate pain sufficiently so that pulmonary function is not

Abdominal surgery

Regional anesthesia for abdominal surgery was introduced at the beginning of the 20th century and developed to become widely used. With advances in techniques and technology, regional anesthesia was extended in the postoperative period to provide good pain relief. It was only in the last 30 years that anesthesiologists started to study the impact of regional anesthesia techniques beyond the intraoperative period on some outcomes relevant to the recovery process.

Conclusions

With better knowledge of the pathophysiological mechanisms of organ dysfunction associated with surgery, anesthesiologists have devised interventions aimed at attenuating the surgical stress response and facilitating the immediate recovery process. Cardiorespiratory and metabolic outcomes have been identified, and perioperative measures have been adopted with the aim to accelerate the return to baseline. Regional anesthesia, by interacting with the transmission of nociceptive stimuli, is a

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