Recent Advances in Regional Anaesthesia: A Comprehensive Review
DOI:
https://doi.org/10.58222/juvokes.v3i2.1186Kata Kunci:
Regional anaesthesia, Ultrasound guided nerve blocks, Pain management, Opioid reduction, PerioperativeAbstrak
Regional anaesthesia has revolutionized modern practice in anaesthesia, and the review will focus on recent technological and procedural developments, with special emphasis on efficacy, safety profiles, and impact on patient outcomes. Recent developments, especially with the integration of ultrasound-guided techniques, have substantially enhanced procedural precision and safety and made possible substantial reductions in opioid requirements. Evidence indicates that such developments bring improved pain control into recovery results in comparison with the traditional general anaesthesia methods. The latter still modulates regional anaesthesia training and implementation through current technological developments and standard teaching methods but still presents problems in standardization of techniques and access. These advances will greatly influence perioperative care, making potentially for shorter stays and improved rehabilitation for patients, with maximum satisfaction through optimal pain management protocols.
Referensi
Albrecht, E., & Chin, K. (2020). Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia, 75, e101-e110.
Elsharkawy, H., El-Boghdadly, K., & Barrington, M. (2019). Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology, 130(2), 322-335.
Cozowicz, C., Poeran, J., Zubizarreta, N., Mazumdar, M., & Memtsoudis, S. G. (2016). Trends in the use of regional anesthesia: neuraxial and peripheral nerve blocks. Regional Anesthesia & Pain Medicine, 41(1), 43-49.
Elisha, S., & Nagelhout, J. J. (2017). Nurse anesthesia-E-book. Elsevier Health Sciences.
Chahrour, M., Chamseddine, H., Kabbani, L., & Aboul Hosn, M. (2024). Regional anesthesia is associated with improved mortality and morbidity in patients with congestive heart failure undergoing lower extremity amputation. Annals of Vascular Surgery, 108, 206–211.
Farrow, R. A., Shalaby, M., Newberry, M. A., Montes De Oca, R., Kinas, D., Farcy, D. A., et al. (2024). Implementation of an ultrasound-guided regional anesthesia program in the emergency department of a community teaching hospital. Annals of Emergency Medicine, 83, 509–518.
Ganta, A., Fisher, N. D., Gibbons, K., Ferati, S. R., Furgiuele, D., Konda, S. R., et al. (2024). Regional anesthesia is safe for use in intramedullary nailing of low-energy tibial shaft fractures. Injury, 55, 111636.
Du J, Li C, Zhang W, Lu X, Xia Y, Qin X. Efficacy and Safety of Adding Ketamine to Lidocaine in Intravenous Regional Anesthesia: A Meta-analysis of Randomized Controlled Trials. J Perianesth Nurs 2024. https://doi.org/10.1016/j.jopan.2024.03.013
Shams, D., Sachse, K., Statzer, N., & Gupta, R. K. (2024). Regional Anesthesia Complications and Contraindications. Anesthesiology clinics, 42(2), 329–344. https://doi.org/10.1016/j.anclin.2023.11.013
Yu, D., Wang, X., Jiang, L., Wu, Y., Han, S., & Li, J. (2024). Evaluating the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta-analysis. International wound journal, 21(4), e14640. https://doi.org/10.1111/iwj.14640
Moorthy, A., Ní Eochagáin, A., Dempsey, E., Wall, V., Marsh, H., Murphy, T., Fitzmaurice, G. J., Naughton, R. A., & Buggy, D. J. (2023). Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebral block after minimally invasive thoracic surgery: a prospective, randomised controlled trial. British journal of anaesthesia, 130(1), e137–e147. https://doi.org/10.1016/j.bja.2022.07.051
Yu, D., Wu, Y., Han, S., Wang, X., & Jiang, L. (2024). Analgesic efficacy of local infiltration anaesthesia versus femoral nerve block in alleviating postoperative wound pain following total knee arthroplasty: A systematic review and meta-analysis. International wound journal, 21(2), e14766. https://doi.org/10.1111/iwj.14766
Hamid, H. K. S., Marc-Hernández, A., & Saber, A. A. (2021). Transversus abdominis plane block versus thoracic epidural analgesia in colorectal surgery: a systematic review and meta-analysis. Langenbeck's archives of surgery, 406(2), 273–282. https://doi.org/10.1007/s00423-020-01995-9
Zhao, Y., Qin, S., Yang, X., Gao, C., Yuan, X., Li, T., & Chen, Z. (2023). Comparison of the anesthesia effect of ultrasound-guided middle and low interscalene brachial plexus block: a randomized, controlled, non-inferiority trial. BMC anesthesiology, 23(1), 1. https://doi.org/10.1186/s12871-022-01963-4
Chen, B., Tan, M., Li, Q., Wang, S., Chen, D., Zhao, M., & Cao, J. (2024). Application of ultrasound-guided single femoral triangle and adductor canal block in arthroscopic knee surgery: a prospective, double-blind, randomized clinical study. BMC anesthesiology, 24(1), 182. https://doi.org/10.1186/s12871-024-02555-0
Aragola, S., Arenson, B., Tenenbein, M., Bohm, E., Jacobsohn, E., & Turgeon, T. (2021). Prospective randomized trial of continuous femoral nerve block with posterior capsular injection versus periarticular injection for analgesia in primary total knee arthroplasty. Canadian journal of surgery. Journal canadien de chirurgie, 64(3), E265–E272. https://doi.org/10.1503/cjs.020519
Vallabhaneni, N., Vanderham, L. C., Jacobson, S., Tobin, J. G., Guareschi, A. S., Eichinger, J. K., et al. (2024). Regional compared to general anesthesia for total shoulder arthroplasty. Seminars in Arthroplasty JSES, 34, 451–456.
Ye, Y., Papadimos, T. J., Xia, Y., & Wang, Q. (2023). Comparison of combined lumbar and PIP block versus general anesthesia on postoperative outcomes in hip surgery. Perioperative Care and Operating Room Management, 32, 100320.
Fang, L., Chen, X., Zhang, H., Bao, X., Duan, G., Cao, T., Jin, M., & Li, H. (2023). Laryngeal mask general anaesthesia versus spinal anaesthesia for promoting early recovery of cervical conisation: A randomised, controlled clinical study. Heliyon, 9(4), e15121.
Uraya, Y., Kawano, Y., Kuroiwa, T., Maeda, A., Funahashi, T., Shizu, K., Suzuki, K., & Fujita, N. (2023). Is local anesthesia or general anesthesia preferable for plate removal after clavicle fracture surgery under general anesthesia? A comparative study using a patient questionnaire. Injury, 54(12), 111144.
Shui, M., Zhao, D., Xue, Z., & Wu, A. (2023). Impact of Spinal/Epidural Anesthesia Versus General Anesthesia on Perioperative Outcomes in Patients Undergoing Lumbar Spine Surgery: An Updated Systematic Review and Meta-analysis. Clinical spine surgery, 36(6), 227–236. https://doi.org/10.1097/BSD.0000000000001374
Perez-Roman, R. J., Govindarajan, V., Bryant, J. P., & Wang, M. Y. (2021). Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurgical focus, 51(6), E7. https://doi.org/10.3171/2021.9.FOCUS21464
Kull, C., Martin, R., Rossel, J. B., Nguyen, A., & Albrecht, E. (2024). Femoral vs sciatic nerve block to provide analgesia after medial open wedge high tibial osteotomy in the setting of multimodal analgesia: A randomized, controlled, single-blinded trial. Journal of clinical anesthesia, 93, 111355. https://doi.org/10.1016/j.jclinane.2023.111355
Chen, R., Su, S., & Shu, H. (2022). Efficacy and safety of rhomboid intercostal block for analgesia in breast surgery and thoracoscopic surgery: a meta-analysis. BMC anesthesiology, 22(1), 71. https://doi.org/10.1186/s12871-022-01599-4
Charvin, M., Longeras, F., Jouve, P., Cherprenet, A. L., Futier, E., Pereira, B., & Dualé, C. (2020). Effects of adding a combined femoral and sciatic nerve block with levobupivacaine and clonidine to general anaesthesia in femoropopliteal bypass surgery: A randomised, double-blind, controlled trial. European journal of anaesthesiology, 37(9), 787–795. https://doi.org/10.1097/EJA.0000000000001263
Kukreja, P., Uppal, V., Kofskey, A. M., Feinstein, J., Northern, T., Davis, C., Morgan, C. J., & Kalagara, H. (2023). Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. British Journal of Anaesthesia, 130(6), 773-779.
Xu, M., Zhang, G., Tang, Y., Wang, R., & Yang, J. (2023). Impact of Regional Anesthesia on Subjective Quality of Recovery in Patients Undergoing Thoracic Surgery: A Systematic Review and Meta-Analysis. Journal of Cardiothoracic and Vascular Anesthesia, 37(9), 1744-1750.
Di Monte, F. F., Turri, G., Di Vittori, A., De Giulio, E., Bicelli, N., Faccioli, G., Sciortino, R., Valdegamberi, A., Ruzzenente, A., & Pedrazzani, C. (2024). Major abdominal surgery under locoregional anesthesia in a patient with primary ciliary dyskinesia: Clinical case. Surgery Case Reports, 2, 100032.
Pascarella, G., Costa, F., Del Buono, R., Pulitanò, R., Strumia, A., Piliego, C., De Quattro, E., Cataldo, R., Agrò, F. E., Carassiti, M., & collaborators (2021). Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial. Anaesthesia, 76(11), 1492–1498. https://doi.org/10.1111/anae.15536
Tang, X., Jiang, X., Lei, L., Zhu, W., Fu, Z., Wang, D., Chen, J., Ning, N., & Zhou, Z. (2022). IPACK (Interspace between the Popliteal Artery and the Capsule of the Posterior Knee) Block Combined with SACB (Single Adductor Canal Block) Versus SACB for Analgesia after Total Knee Arthroplasty. Orthopaedic surgery, 14(11), 2809–2821. https://doi.org/10.1111/os.13263
Mongelli, F., Treglia, G., La Regina, D., Di Giuseppe, M., Galafassi, J., Majno-Hurst, P. E., & Christoforidis, D. (2021). Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis. Diseases of the colon and rectum, 64(5), 617–631. https://doi.org/10.1097/DCR.0000000000001985
Gautam, S., Pande, S., Agarwal, A., Agarwal, S. K., Rastogi, A., Shamshery, C., & Singh, A. (2020). Evaluation of Serratus Anterior Plane Block for Pain Relief in Patients Undergoing MIDCAB Surgery. Innovations (Philadelphia, Pa.), 15(2), 148–154. https://doi.org/10.1177/1556984520908962
Kaushal, B., Chauhan, S., Magoon, R., Krishna, N. S., Saini, K., Bhoi, D., & Bisoi, A. K. (2020). Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy. Journal of cardiothoracic and vascular anesthesia, 34(4), 981–986. https://doi.org/10.1053/j.jvca.2019.08.009
Machiyama Y, Ogawa T, Matsuo T, Sim J, Takeda J, Kameda S, et al. Association between smoking and duration of regional anesthesia – A propensity score matching study. J Orthop Sci 2024. https://doi.org/10.1016/j.jos.2024.06.012.
Yung, E. M., Got, T. C., Patel, N., Brull, R., & Abdallah, F. W. (2021). Intra-articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta-analysis. Anaesthesia, 76(4), 549–558. https://doi.org/10.1111/anae.15172
Harkouk, H., Fletcher, D., & Martinez, V. (2021). Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery. Regional anesthesia and pain medicine, 46(3), 251–257. https://doi.org/10.1136/rapm-2020-102040
Pepper, C. G., Mikhaeil, J. S., & Khan, J. S. (2024). Perioperative Regional Anesthesia on Persistent Opioid Use and Chronic Pain after Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesthesia and analgesia, 139(4), 711–722. https://doi.org/10.1213/ANE.0000000000006947
Mantovani, G., Sgarbanti, L., Indaimo, A., Cavallo, M. A., De Bonis, P., Flacco, M. E., & Scerrati, A. (2023). Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial. Neurosurgical focus, 55(6), E13. https://doi.org/10.3171/2023.9.FOCUS23549
Borys, M., Zamaro, A., Horeczy, B., Gęszka, E., Janiak, M., Węgrzyn, P., Czuczwar, M., & Piwowarczyk, P. (2021). Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study. International journal of environmental research and public health, 18(7), 3500. https://doi.org/10.3390/ijerph18073500
Duda, T., Lannon, M., Gandhi, P., Martyniuk, A., Farrokhyar, F., & Sharma, S. (2023). Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy. Neurosurgery, 93(1), 4–23. https://doi.org/10.1227/neu.0000000000002381
Torosis, M., Fullerton, M., Kaefer, D., Nitti, V., Ackerman, A. L., & Grisales, T. (2024). Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial. Urogynecology (Philadelphia, Pa.), 30(8), 706–713. https://doi.org/10.1097/SPV.0000000000001448
La Via, L., Cavaleri, M., Terminella, A., Sorbello, M., & Cusumano, G. (2024). Loco-Regional Anesthesia for Pain Management in Robotic Thoracic Surgery. Journal of clinical medicine, 13(11), 3141. https://doi.org/10.3390/jcm13113141
Lazar, A. E., Butiulca, M., & Farczadi, L. (2024). Challenges of the Regional Anesthetic Techniques in Intensive Care Units - A Narrative Review. Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures), 10(3), 198–208. https://doi.org/10.2478/jccm-2024-0023
Yang, M., Cao, L., Lu, T., Xiao, C., Wu, Z., Jiang, X., Wang, W., & Li, H. (2024). Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomies surgery: a randomized controlled trial. Trials, 25(1), 10. https://doi.org/10.1186/s13063-023-07866-0
Häggström M, Brodin K. The meaning of being conscious during surgery with local or regional anesthesia–A phenomenological hermeneutic study. Int J Nurs Stud Adv 2024;7:100224.
Siniakova, T., Lombardi, C., Wofford, K., & Maye, J. (2024). Assessing the Quality of Postoperative Recovery: A Guide for Making Adjustments in Anesthesia Delivery. Journal of PeriAnesthesia Nursing, 39(3), 356-365.
Beguinot, M., Monrigal, E., Kwiatkowski, F., Ginzac, A., Joly, D., Gayraud, G., Le Bouedec, G., & Gimbergues, P. (2020). Continuous Wound Infiltration With Ropivacaine After Mastectomy: A Randomized Controlled Trial. The Journal of surgical research, 254, 318–326. https://doi.org/10.1016/j.jss.2020.05.006
Li, L., Liu, M., Li, S., Xu, J., Zheng, J., Lv, C., Wu, L., & Heng, L. (2023). Influence of Regional Nerve Block in Addition to General Anesthesia on Postoperative Delirium, Pain, and In-hospital Stay in Patients Undergoing Cardiothoracic Surgery: A Meta-analysis. Journal of cardiovascular pharmacology, 82(6), 496–503. https://doi.org/10.1097/FJC.0000000000001469
Dufour, E., Jaziri, S., Novillo, M. A., Aubert, L., Chambon, A., Kutz, R., Vallée, A., & Fischler, M. (2022). A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection. Scientific reports, 12(1), 52. https://doi.org/10.1038/s41598-021-03660-7
Christiansen, C. B., Madsen, M. H., Rothe, C., Andreasen, A. M., Lundstrøm, L. H., & Lange, K. H. W. (2020). Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta anaesthesiologica Scandinavica, 64(2), 238–244. https://doi.org/10.1111/aas.13489
Rodrigues, D., Amadeo, R. J. J., Wolfe, S., Girling, L., Funk, F., Fidler, K., Brown, H., Leiter, J., Old, J., MacDonald, P., Dufault, B., & Mutter, T. C. (2021). Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial. Durée analgésique du bloc interscalénique après une chirurgie arthroscopique de l’épaule en ambulatoire avec dexaméthasone intraveineuse, dexmédétomidine intraveineuse, ou leur combinaison: une étude randomisée contrôlée. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 68(6), 835–845. https://doi.org/10.1007/s12630-021-01942-2
Albrecht, E., & Chin, K. J. (2020). Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia, 75 Suppl 1, e101–e110. https://doi.org/10.1111/anae.14868
Rawal N. (2021). Epidural analgesia for postoperative pain: Improving outcomes or adding risks?. Best practice & research. Clinical anaesthesiology, 35(1), 53–65. https://doi.org/10.1016/j.bpa.2020.12.001
Li, S., Chen, W., Feng, L., & Guo, X. (2024). Optimal analgesic regimen for total shoulder arthroplasty: a randomized controlled trial and network meta-analysis. Journal of orthopaedic surgery and research, 19(1), 57. https://doi.org/10.1186/s13018-023-04451-8
Thepsoparn, M., Punyawattanakit, P., Jaruwangsanti, N., Singhatanadgige, W., & Chalermkitpanit, P. (2022). Effects of general anesthesia with and without thoracic epidural block on length of stay after open spine surgery: a single-blinded randomized controlled trial. The spine journal : official journal of the North American Spine Society, 22(10), 1694–1699. https://doi.org/10.1016/j.spinee.2022.05.015
Adeola, J. O., Wall, P. V., Mehdipour, S., Macias, A. A., & Gabriel, R. A. (2023). Racial and Ethnic Differences in the Use of Regional Anesthesia for Patients Undergoing Total Knee Arthroplasty. The Journal of Arthroplasty, 38(9), 1663-1667.
Hansen, C., Dam, M., Nielsen, M. V., Tanggaard, K. B., Poulsen, T. D., Bendtsen, T. F., & Børglum, J. (2021). Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial. Regional anesthesia and pain medicine, 46(1), 25–30. https://doi.org/10.1136/rapm-2020-101931
Opperer, M., Kaufmann, R., Meissnitzer, M., Enzmann, F. K., Dinges, C., Hitzl, W., Nawratil, J., & Koköfer, A. (2022). Depth of cervical plexus block and phrenic nerve blockade: a randomized trial. Regional anesthesia and pain medicine, 47(4), 205–211. https://doi.org/10.1136/rapm-2021-102851
Guay, J., & Kopp, S. (2020). Peripheral nerve blocks for hip fractures in adults. The Cochrane database of systematic reviews, 11(11), CD001159. https://doi.org/10.1002/14651858.CD001159.pub3
King, M., Stambulic, T., Servito, M., Mizubuti, G. B., Payne, D., & El-Diasty, M. (2022). Erector spinae plane block as perioperative analgesia for midline sternotomy in cardiac surgery: A systematic review and meta-analysis. Journal of cardiac surgery, 37(12), 5220–5229. https://doi.org/10.1111/jocs.17005
Chuan A, Bogdanovych A, Moran B, Chowdhury S, Lim YC, Tran MT, et al. Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial. J Clin Anesth 2024;97:111535.
Zhang X, Vanstone RJ, Turbitt L, West S, Harty E. Regional anaesthesia education for consultants and specialists in the UK: a mixed-methods analysis. Br J Anaesth 2024;132:1073-81.
Ferry J, Lewis O, Lloyd J, El-Boghdadly K, Kearns R, Albrecht E, et al. Research priorities in regional anaesthesia: an international Delphi study. Br J Anaesth 2024;132:1041-8.
Dmytriiev, D., Dîrzu, D. S., Melnychenko, M., & Eichholz, R. (2022). Erector spinae plane block for affective and safe analgesia in a patient with severe penetrating chest trauma caused by an explosion in the battlefield. Clinical Case Reports, 10(10), e6433.
Andersen, C. H. S., Laier, G. H., Nielsen, M. V., Dam, M., Hansen, C. K., Tanggaard, K., & Børglum, J. (2020). Transmuscular quadratus lumborum block for percutaneous nephrolithotomy: Study protocol for a dose-finding trial. Acta anaesthesiologica Scandinavica, 64(8), 1224–1228. https://doi.org/10.1111/aas.13605












_1.png)
