Regional Anesthesia in the Context of Enhanced Recovery after Surgery

Abstract

In the context of enhanced recovery after surgery（ERAS）, perioperative pain management is provided based on a concept of multimodal analgesia. While minimizing the use of opioids, paracetamol and non-steroidal anti-inflammatory drugs are generally administered. When severe postoperative pain is expected, regional analgesic technique can be applied. The role of epidural analgesia for perioperative pain management in abdominal and thoracic surgeries is declining because of its adverse effects. At the same time, the importance of peripheral nerve blocks including fascial plane block is increasing, though the evidence of their use for perioperative analgesia of abdominal and thoracic surgeries is still insufficient. Although peripheral nerve block technique is useful for analgesia after lower extremity total joint replacement surgery, its influence on ambulation should be considered. Interscalene brachial plexus block is recommended as the first-choice regional anesthetic technique for rotator cuff repair surgery. Regional anesthesia is one of the critical components of an optimal multimodal analgesia for ERAS program.