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Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 4/2017

01-12-2017 | Geriatric Anesthesia (S Akhtar, Section Editor)

Regional Versus General Anesthesia in the Elderly: New Insights

Authors: Jonathan Dun-Chi Lin, Jean-Pierre Philip Ouanes, Frederick E. Sieber

Published in: Current Anesthesiology Reports | Issue 4/2017

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Abstract

The comparison between regional anesthesia and general anesthesia is a continually evolving debate. Each technique has pros and cons, and the selection of anesthetic approach is highly dependent on specific indications, patient comorbidities, and type of surgery. Elderly patients, who are more likely to have multiple comorbidities and overall frailty, require a more nuanced approach. In this article, we review the literature for differences in various outcomes between regional anesthesia and general anesthesia. We summarize systematic reviews, meta-analyses, and literature reviews, focusing on results in the past decade. Notable differences in outcomes are discussed, especially those pertinent to the geriatric population. Regional anesthesia may be associated with multiple benefits despite differences in clinical practice over the years. Further research is needed to elucidate these benefits.
Literature
1.
Hang J. The controversy of regional vs. general anesthesia in surgical outcome. In: Sieber FE, editor. Geriatric anesthesia. New York: The McGraw-Hill Companies, Inc.; 2007.
2.
Kehlet H. Influence of regional anaesthesia on postoperative morbidity. Ann Chir Gynaecol. 1984;73(3):171–6.PubMed
3.
Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology. 1992;77(6):1095–104.CrossRefPubMed
4.
Atanasoff PG. Effects of regional anesthesia on perioperative outcome. J Clin Anesth. 1996;8(6):446–55.CrossRef
5.
Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321(7275):1493.CrossRefPubMedPubMedCentral
6.
Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North Am. 2000;18(1):91–104. viiCrossRef
7.
Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93(4):853–8.CrossRefPubMed
8.
Lien CA. Regional versus general anesthesia for hip surgery in older patients: does the choice affect patient outcome? J Am Geriatr Soc. 2002;50(1):191–4.CrossRefPubMed
9.
Breen P, Park KW. General anesthesia versus regional anesthesia. Int Anesthesiol Clin. 2002;40(1):61–71.CrossRefPubMed
10.
Wu CL, Anderson GF, Herbert R, et al. Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in Medicare patients. Reg Anesth Pain Med. 2003;28(4):271–8.PubMed
11.
Wu CL, Hurley RW, Anderson GF, et al. Effect of postoperative epidural analgesia on morbidity and mortality following surgery in Medicare patients. Reg Anesth Pain Med. 2004;29(6):525–33.CrossRefPubMed
12.
Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004;4:CD000521.
13.
Liu SS, Block BM, Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology. 2004;101(1):153–61.CrossRefPubMed
14.
Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21(14):895–910.CrossRefPubMed
15.
Gulur P, Nishimori M, Ballantyne JC. Regional anaesthesia versus general anaesthesia, morbidity and mortality. Best Pract Res Clin Anaesthesiol. 2006;20(2):249–63.CrossRefPubMed
16.
Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res. 2009;467(9):2379–402.CrossRefPubMedPubMedCentral
17.
Svircevic V, van Dijk D, Nierich AP, et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology. 2011;114(2):271–82.CrossRefPubMed
18.
Barbosa FT, Jucá MJ, Castro AA, et al. Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database Syst Rev. 2013;7:CD007083.
19.
Barbosa FT, Castro AA. Neuraxial anesthesia versus general anesthesia for urological surgery: a systematic review. Sao Paulo Med J. 2013;131(3):179–86.CrossRefPubMed
20.
Barbosa FT, Castro AA, Sousa-Rodrigues CF. Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials. Sao Paulo Med J. 2013;131(6):411–21.CrossRefPubMed
21.
Unic-Stojanovic D, Babic S, Neskovic V. General versus regional anesthesia for carotid endarterectomy. J Cardiothorac Vasc Anesth. 2013;27(6):1379–83.CrossRefPubMed
22.
Cakmakkaya OS, Kolodzie K, Apfel CC, et al. Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev. 2014;11:CD008877.
23.
• Zhang S, Wu X, Guo H, et al. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur J Med Res. 2015;20(1):25. This article is important because it found that the addition of TEA to GA decreased respiratory complications, supraventricular arrhythmias, pain, length of ICU stay, and time to tracheal extubation. This is promising, as TEA is not usually utilized for cardiac surgery. CrossRefPubMedPubMedCentral
24.
Guay J, Parker MJ, Gajendragadkar PR, et al. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2:CD000521.PubMed
25.
Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int. 2010;21(Suppl 4):S555–72.CrossRefPubMed
26.
Guay J, Choi P, Suresh S, et al. Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014;1:CD010108.
27.
Pöpping DM, Elia N, Van Aken HK, et al. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2014;259(6):1056–67.CrossRefPubMed
28.
Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62–72.CrossRefPubMed
29.
Richman JM, Liu SS, Courpas G, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102(1):248–57.CrossRefPubMed
30.
Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22(Suppl 3):67–79.CrossRefPubMed
31.
Davis N, Lee M, Lin AY, et al. Postoperative cognitive function following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol. 2014;26(4):369–76.CrossRefPubMedPubMedCentral
32.
Zywiel MG, Prabhu A, Perruccio AV, et al. The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res. 2014;472(5):1453–66.CrossRefPubMed
33.
Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290(18):2455–63.CrossRefPubMed
34.
Beattie WS, Badner NH, Choi PT. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesth Analg. 2003;97(3):919–20.CrossRefPubMed
35.
Ballantyne JC, Carr DB, de Ferranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcomes: cumulative meta-analysis of randomized controlled trials. Anesth Analg. 1998;86:598–612.CrossRefPubMed
36.
Mergeay M, Verster A, Van Aken D, et al. Regional versus general anesthesia for spine surgery. A comprehensive review. Acta Anaesthesiol Belg. 2015;66(1):1–9.PubMed
37.
Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg. 2006;103(4):1018–25.CrossRefPubMed
38.
39.
Pu C, Wang J, Tang Y, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis. 2015;43(5):455–66.CrossRefPubMed
40.
Zorrilla-Vaca A, Grant MC, Mathur V, Li J, Wu CL. The impact of neuraxial versus general anesthesia on the incidence of postoperative surgical site infections following knee or hip arthroplasty: a meta-analysis. Reg Anesth Pain Med. 2016;41(5):555–63.CrossRefPubMed
41.
Liu SS, Strodtbeck WM, Richman JM, et al. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101(6):1634–42.CrossRefPubMed
42.
Tahiri Y, Tran DQ, Bouteaud J, et al. General anaesthesia versus thoracic paravertebral block for breast surgery: a meta-analysis. J Plast Reconstr Aesthet Surg. 2011;64(1):1261–9.CrossRefPubMed
43.
De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39–43.CrossRefPubMed
44.
Law LS, Tan M, Bai Y, et al. Paravertebral block for inguinal herniorrhaphy: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2015;121(2):556–69.CrossRefPubMed
45.
• Kehlet H, Aasvang EK. Regional or general anesthesia for fast-track hip and knee replacement—what is the evidence? F1000Res. 2015;4: F1000 Faculty Rev-1449. This article is important because it identified a need for future studies comparing RA with optimized, modern GA techniques featuring multimodal, opioid-sparing analgesia.
Metadata
Title
Regional Versus General Anesthesia in the Elderly: New Insights
Authors
Jonathan Dun-Chi Lin
Jean-Pierre Philip Ouanes
Frederick E. Sieber
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2017
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-017-0236-3

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