Regional Anaesthesia- Should We Be Keeping More Patients Awake?

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Doctor: “There is an option to stay awake for the procedure. What would you prefer?”
Patient: “Well, I don’t know doctor. Which would you choose?”

It’s a difficult question. The literature has shown that each to have their benefits but also disadvantages. Several considerations should be taken into account such as the co-morbidities of the patient, the type and duration of the surgery, experience of the anaesthetist and patient preference – some patients may rather be asleep; some theatre personnel may also prefer their patients to be asleep!

Introduction
Regional anaesthesia (RA) is the loss of sensation of part of the body by the use of local anaesthetics. It can be used as an alternative to general anaesthesia (GA) where all sensation and awareness is lost during the procedure. Patients are thus provided with an option to remain awake during their procedure in RA. RA is also indicated for analgesia or combined with a GA to reduce post-operative analgesia requirements.

The popularity of RA has varied since its discovery- we all know the analgesic benefits of applying ice or heat on an area and this was likely the first use of ‘regional anaesthesia’ hundreds of years ago. Indigenous South Americans discovered the numbing effects of chewing coca leaves long before cocaine was isolated from the leaves. Karl Koller and Sigmund Freund first described the anaesthetic effects of cocaine during ophthalmologic procedures in 1884 (1). There were several pioneers of RA in the years that followed. Improvements were made when less toxic pharmacological agents such as Lidocaine in 1943 were discovered and better techniques developed. In recent years, the use of RA has become increasingly popular in several areas of medicine. An audit of h...

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