Regional anaesthesia versus general anaesthesia

The debate over the theoretical superiority of regional over general anaesthesia has persisted throughout most of the twentieth century, and there is still no satisfactory answer to the question of whether avoidance of general anaesthesia saves lives or reduces morbidity. This chapter reviews and analyses the evidence supporting an effect on surgical outcome of anaesthetic choice. For carotid endarterectomy, using regional anaesthesia rather than general anaesthesia enables keeping patients awake during carotid artery clamping. The chapter summarizes the key evidence supporting advantages or disadvantages of intraoperative neuraxial anaesthesia on postoperative outcomes. It also discusses selected topics regarding postoperative outcome after sole regional anaesthesia versus general anaesthesia. Meta-analysis and systematic reviews are cited, and emphasis is given to randomised controlled trials (RCTs). Evidence suggests the possibility of reduced mortality among several specific patient populations such as hip fracture surgery under spinal anaesthesia.