Anesthesia is given to the patients to block the sensation of pain. Regional Anesthesia helps to continue procedures without losing consciousness of the body. It is mainly used in minor procedures, to help the patient lose the sensation of pain by relaxing the muscles or nerves in injured path or location.
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The aim of this article is to review current data of Medline, PubMed and other databases on the effect of local anaesthetics (LAs) with respect to: mechanism of action, effect on postoperative and traumatic ileus, neuroprotection, prevention of cancer recurrence, immune system preserving effect (antiinflammatory and antimicrobial) and novel indications of LAs. Over the last decade scientific studies proved that LAs can interact with other receptors. Besides causing anaesthesia, the LAs may act directly on other receptors and their signaling pathways which are involved in processes of inflammation, platelet activation, nociception, peripheral pain and arrhythmias. Besides reduction in postoperative pain intensity at 6 and 12 h, perioperative use of systemic LAs for abdominal surgery is associated with reduction of opioid dose, length of hospital stay by 4 h, faster recovery of bowel function (peristalsis earlier by 8 h, first flatus by 14 h, less PONV). Several animal studies have proved neuroprotective effect of intravenous lidocaine. It reduces the level of glutamate in the hippocampus and cortex, attenuates apoptosis in the ischaemic area and reduces infarct size, thus improving recovery after hypothermic ischaemia. Long-term effect of anaesthesia/analgesia - reduction of cancer recurrence – was confirmed in several studies (breast, colonic, prostate). LAs reduce surgery-induced immune alterations by reducing production of both pro- and antinflammatory interleukines and also have antimicrobial properties and inhibit different m/o growth in vitro. In conclusion, besides analgesia and antiarrhythmia, local anaesthetics produce faster recovery of bowel function, mobility, reduced hospital stay, have neuroprotective and antimicrobial properties, reduction of inflammation and incidence of cancer recurrence. Further studies regarding safety and determination of optimal dosage are still needed.
Regional techniques in pediatrics are increasingly used in the perioperative medicine. Intraoperative and postoperative pain control in infants and children is one of the basic fields of any anesthesiologist, and regional anesthesia plays currently an important role to both chronic and acute pain control. Although commonly performed in the pediatric population through the years, these techniques have also being critized when performed under sedation or general anesthesia since some complications cannot be reported. However, safety studies support regional techniques under general anesthesia as a safe practice.