Long-term Functional Outcomes after Regional Anesthesia: A Summary of the Published Evidence and a Recent Cochrane Review.

Abstract

population-based average effects or biomarkers as evidence of meaningful improvement in care are unconvincing in this day and age. Outcomes suitable as arguments for the sustained value of regional anesthesia should instead be patient centered. Patient preferences, shared decision-making, and individualized tailored care are the hallmarks of this new paradigm in outcomes research, differentiating it from previous concepts of comparative effectiveness research. Much needs to be done to define and investigate patient-centered outcomes in anesthesiology and pain medicine, especially long-term outcomes. Pay for performance is another emerging concept, forcing us to emphasize our unique contribution to the quality of patient outcomes. What is the added value that anesthesiologists providing patients regional anesthesia contribute in the long run in the perioperative surgical home, where these anesthesiology subspecialists serve as the shepherds guiding the individualized perioperative recovery process? Outcomes suitable as arguments for the sustained value of regional anesthesia should be patient centered. Pain, Function, and Cognition as Cornerstones of Meaningful Long-term Recovery In this chapter, we examine the clinical evidence suggesting that regional anesthesia has meaningful benefits for our patients and society beyond the immediate perioperative period. Although there are several other outcomes of interest, such as morbidity and mortality or cancer recurrence, we focus on three long-term outcomes after elective surgery based on their particular importance: (1) Persistent pain (2) Joint function (3) Cognitive outcomes We also selected these outcomes because their impact and significance are easy to convey to any interlocutor—surgical colleague, lay person, hospital administrator, or politician— regardless of their previous training or experience. FOCUS 1: REGIONAL ANESTHESIA FOR THE PREVENTION OF PERSISTENT PAIN AFTER SURGERY