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Erschienen in: Current Anesthesiology Reports 4/2017

01.12.2017 | Geriatric Anesthesia (S Akhtar, Section Editor)

Regional Versus General Anesthesia in the Elderly: New Insights

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

Erschienen in: Current Anesthesiology Reports | Ausgabe 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.
Literatur
1.
Zurück zum Zitat 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. 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.
Zurück zum Zitat Kehlet H. Influence of regional anaesthesia on postoperative morbidity. Ann Chir Gynaecol. 1984;73(3):171–6.PubMed Kehlet H. Influence of regional anaesthesia on postoperative morbidity. Ann Chir Gynaecol. 1984;73(3):171–6.PubMed
3.
Zurück zum Zitat Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology. 1992;77(6):1095–104.CrossRefPubMed Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology. 1992;77(6):1095–104.CrossRefPubMed
4.
Zurück zum Zitat Atanasoff PG. Effects of regional anesthesia on perioperative outcome. J Clin Anesth. 1996;8(6):446–55.CrossRef Atanasoff PG. Effects of regional anesthesia on perioperative outcome. J Clin Anesth. 1996;8(6):446–55.CrossRef
5.
Zurück zum Zitat 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 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.
Zurück zum Zitat Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North Am. 2000;18(1):91–104. viiCrossRef Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North Am. 2000;18(1):91–104. viiCrossRef
7.
Zurück zum Zitat Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93(4):853–8.CrossRefPubMed Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg. 2001;93(4):853–8.CrossRefPubMed
8.
Zurück zum Zitat 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 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.
Zurück zum Zitat Breen P, Park KW. General anesthesia versus regional anesthesia. Int Anesthesiol Clin. 2002;40(1):61–71.CrossRefPubMed Breen P, Park KW. General anesthesia versus regional anesthesia. Int Anesthesiol Clin. 2002;40(1):61–71.CrossRefPubMed
10.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004;4:CD000521. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004;4:CD000521.
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21(14):895–910.CrossRefPubMed Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21(14):895–910.CrossRefPubMed
15.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Barbosa FT, Jucá MJ, Castro AA, et al. Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database Syst Rev. 2013;7:CD007083. Barbosa FT, Jucá MJ, Castro AA, et al. Neuraxial anaesthesia for lower-limb revascularization. Cochrane Database Syst Rev. 2013;7:CD007083.
19.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Unic-Stojanovic D, Babic S, Neskovic V. General versus regional anesthesia for carotid endarterectomy. J Cardiothorac Vasc Anesth. 2013;27(6):1379–83.CrossRefPubMed 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.
Zurück zum Zitat Cakmakkaya OS, Kolodzie K, Apfel CC, et al. Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev. 2014;11:CD008877. Cakmakkaya OS, Kolodzie K, Apfel CC, et al. Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev. 2014;11:CD008877.
23.
Zurück zum Zitat • 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 • 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.
Zurück zum Zitat Guay J, Parker MJ, Gajendragadkar PR, et al. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2:CD000521.PubMed Guay J, Parker MJ, Gajendragadkar PR, et al. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2:CD000521.PubMed
25.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62–72.CrossRefPubMed Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62–72.CrossRefPubMed
29.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290(18):2455–63.CrossRefPubMed Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290(18):2455–63.CrossRefPubMed
34.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat • 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. • 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.
Metadaten
Titel
Regional Versus General Anesthesia in the Elderly: New Insights
verfasst von
Jonathan Dun-Chi Lin
Jean-Pierre Philip Ouanes
Frederick E. Sieber
Publikationsdatum
01.12.2017
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 4/2017
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-017-0236-3

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