Various beneficial effects derived from neuraxial blocks have been reported, but it is unclear whether these effects have an influence on perioperative mortality and major pulmonary and cardiovascular complications. This overview summarizes Cochrane Reviews assessing the effects of neuraxial blockade on perioperative rates of death, chest infection, and myocardial infarction. Associated Cochrane Clinical Answer: How does neuraxial blockade compare with general anesthesia and systemic analgesia when used postoperatively?

Regional anaesthesia may reduce the rate of persistent postoperative pain, a frequent and debilitating condition. This review aims to compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent postoperative pain beyond three months in adults and children undergoing elective surgery. Associated Cochrane Clinical Answer: How does local and regional anesthesia compare with conventional analgesia for women with persistent pain after breast cancer surgery?

Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. Transient neurological symptoms occurring during the immediate postoperative period are typically observed after the use of spinal lidocaine. Spinal lidocaine does however have a beneficial pharmacokinetic profile, especially for day case surgery. This review determines the prevalence of transient neurological symptoms after spinal anaesthesia with lidocaine. Associated Cochrane Clinical Answer: How do lidocaine and bupivacaine compare with each other and with alternative local anesthetics for adults undergoing spinal anesthesia?

Epidural block remains one of the main regional anaesthesia techniques, and its success depends on correct identification of the epidural space. For several decades, the decision of whether to use air or physiological saline during the loss of resistance technique for identification of the epidural space has been influenced by the anaesthetist’s personal experience. This review evaluates the efficacy and safety of both air and saline in the loss of resistance technique for identification of the epidural space, as well evaluating complications related to the air or saline injected. Associated Cochrane Clinical Answer: How does air compare with saline in the loss of resistance technique for identification of the epidural space?

Peripheral nerve blocks can be performed using ultrasound guidance. It is not yet clear whether this method of nerve location has benefits over other existing methods. This review assesses whether the use of ultrasound to guide peripheral nerve blockade has any advantages over other methods of peripheral nerve location.

Bupivacaine is an amide local anaesthetic used in hyperbaric and isobaric forms. These are administered intrathecally into the spine to provide regional anaesthesia for caesarean section. Several trials have compared hyperbaric and isobaric bupivacaine, without conclusively showing the benefit of either. This review aims to determine the effectiveness and safety of hyperbaric bupivacaine compared to isobaric bupivacaine for spinal anaesthesia in women undergoing caesarean section.

Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This review compares the relative effects (benefits and harms) of three injection techniques (single, double, and multiple) of axillary block of the brachial plexus for distal upper extremity surgery without the use of ultrasound guidance. Associated Cochrane Clinical Answer: What are the effects of different injection techniques during non-ultrasound guided axillary brachial plexus block for adults undergoing distal arm surgery?

Peripheral nerve block can be used for anaesthesia or postoperative analgesia. A limitation to its use for postoperative analgesia is that the analgesic effect lasts only a few hours, after which moderate-to-severe pain at the surgical site may result in the need for alternative analgesics. Several adjuvants have been used to prolong the duration of peripheral nerve block, including perineural or intravenous dexamethasone. This review evaluates the comparative efficacy and safety of perineural dexamethasone versus placebo, intravenous dexamethasone versus placebo, and perineural dexamethasone versus intravenous dexamethasone when added to peripheral nerve block for postoperative pain relief. Associated Cochrane Clinical Answers: Can adding perineural or intravenous dexamethasone to peripheral nerve blocks improve outcomes for adults undergoing surgery? and How does perineural dexamethasone compare with intravenous dexamethasone when used as an adjunct to peripheral nerve block in adolescents and adults undergoing surgery?

Adrenaline combined with lidocaine can prolong digital nerve block and in theory help to provide a bloodless operating field. Extended postoperative pain relief can reduce the need for analgesics and can facilitate hand rehabilitation. Conventionally, adrenaline is avoided at anatomical sites with end arteries because of concerns about arterial spasm, ischaemia and the development of gangrene distal to the site of drug infiltration. This review assesses the safety and efficacy of use of adrenaline combined with lidocaine for digital nerve blocks. Associated Cochrane Clinical Answer: How does lidocaine alone compare with lidocaine plus epinephrine for digital nerve blocks?

Poor postoperative pain management is thought to be associated with an increased risk of morbidity and mortality. Liposomal bupivacaine is an analgesic offering a novel method of sustained release. This review assesses the analgesic efficacy and adverse effects of liposomal bupivacaine when used for peripheral nerve block for the management of postoperative pain.

Regional anaesthesia is thought to be more effective than conventional analgesia for controlling pain and so enables more rapid mobilization after large joint replacement. It remains unclear whether regional anaesthesia improves functional outcomes in the longer term after large joint replacement. This review assesses the effects of regional anaesthesia on long‐term functional outcomes after elective major joint replacement surgery. Associated Cochrane Clinical Answer: What are the effects of regional analgesia for improving long‐term functional outcomes after elective total knee replacement?

Total knee replacement is a common operation with significant requirements for postoperative analgesia. Femoral nerve block is frequently utilized as an option to reduce pain and enable mobilization postoperatively. This review evaluates the benefits and risks of femoral nerve block used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing total knee replacement. Associated Cochrane Clinical Answer: For people post knee replacement surgery, how does femoral nerve block (FNB) compare with opioids, epidural, or local infiltration analgesia?

To facilitate the postoperative rehabilitation of hip replacements, pain must be adequately treated. Peripheral nerve blocks and neuraxial blocks have been proposed to replace or supplement systemic analgesia. This review of compares the relative effects (benefits and harms) of the different nerve blocks that may be used to relieve pain after elective hip replacement in adults. Associated Cochrane Clinical Answer: How do peripheral nerve blocks compare with no peripheral nerve block for adults undergoing hip replacement surgery?

Hip fracture in adults carries a significant morbidity and mortality if surgical treatment is delayed. There is significant debate as to whether regional or general anaesthesia provides the best outcomes for hip fracture repair. This review focuses on comparing outcomes for regional versus general anaesthesia for proximal femoral fracture repair in adults. Associated Cochrane Clinical Answer: How does a neuraxial block compare with general anesthesia in adults undergoing hip fracture surgery?

Various nerve blocks with local anaesthetic agents have been used for analgesia after hip fracture and subsequent surgery. This review focuses on the use of peripheral nerves blocks as preoperative analgesia, postoperative analgesia, or as a supplement to general anaesthesia for hip fracture surgery. Associated Cochrane Clinical Answer: What are the effects of peripheral nerve blocks in people with hip fracture?

Peripheral regional anaesthesia techniques are well established for postoperative pain treatment following knee surgery. The adductor canal block is a technique which can be applied as a single shot or by catheter for continuous regional analgesia. This review compares the analgesic efficacy and adverse events of adductor canal block versus other regional analgesic techniques or systemic analgesia for adults undergoing knee surgery. Associated Cochrane Clinical Answer: How does adductor canal block compare with sham treatment or femoral nerve block for adults undergoing knee surgery?

Major shoulder surgery is associated with severe postoperative pain with many different analgesic techniques being utilized to enable patient comfort and effective joint mobilization postoperatively. These techniques have included opioid and non‐opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint, and regional anaesthesia. This review evaluates the analgesic efficacy of continuous interscalene brachial plexus block with parenteral opioid analgesia for pain relief after major shoulder surgery. Associated Cochrane Clinical Answer: Following major shoulder surgery, how does continuous interscalene brachial plexus block compare with parenteral analgesia for pain relief?

Epidural analgesia is thought to offer improved analgesia compared with systemic opioid‐based medications, but its effect on morbidity and mortality is unclear. This review assesses the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid‐based analgesia for adults undergoing elective abdominal aortic surgery. Associated Cochrane Clinical Answer: How does epidural pain relief compare with systemic opioid-based pain relief in people undergoing abdominal aortic surgery?

Transient gastrointestinal paralysis, nausea, vomiting, and pain are significant clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting, while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization, and hospital costs. This review compares the effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids. Associated Cochrane Clinical Answer: How does epidural local anesthetics compare with opioid-based analgesia for improving outcomes in adults undergoing abdominal surgery?

Intravenous patient‐controlled analgesia (IVPCA) and epidural analgesia, using either continuous or patient‐controlled techniques, are popular approaches for analgesia following intra‐abdominal surgery. Despite several attempts to compare the risks and benefits, the optimal form of analgesia for these procedures is still debated. This review compares and evaluates both forms of epidural analgesia to IVPCA. Associated Cochrane Clinical Answer: For adults with pain following intra-abdominal surgery, how does epidural analgesia compare with intravenous patient-controlled analgesia (IV PCA)?

General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, the use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization required during surgery. This review aims to determine the impact of perioperative epidural analgesia in adults undergoing cardiac surgery, with or without cardiopulmonary bypass, on perioperative mortality and cardiac, pulmonary, or neurological morbidity. Associated Cochrane Clinical Answer: How does perioperative epidural analgesia compare with systemic analgesia for adults undergoing cardiac surgery?

Thoracic surgery often results in severe postoperative pain due to dissection through ribs and intercostal muscles. Inadequate analgesia after surgery can impede recovery and increase the risks of developing complications such as atelectasis, pneumonia, and thrombosis, due to ineffective breathing, clearing of secretions, and poor mobilization. Effective management of acute pain following thoracotomy may prevent these complications and reduce the likelihood of developing chronic pain. This review compares the two regional techniques of thoracic epidural and paravertebral block in adults undergoing elective thoracotomy. Associated Cochrane Clinical Answer: How does a paravertebral block compare with a thoracic epidural in people undergoing thoracotomy?