Regional Anesthesia-a Reappraisal

The anesthesiologist should be equally skilled in all anesthetic methods, both general and regional. Regional anesthesia is remarkably flexible in application. Regional blocks of the extremities do not upset the systemic water-electrolyte balance, the blood chemistry, or the functions of kidney, liver, and heart. When used in situations to which it is adapted it causes the least possible disturbance of bodily functions. It affords complete muscular relaxation which is limited to the part involved. While balanced general anesthesia is superior to regional techniques in major operations on the head, neck, thorax, and upper abdominal cavity, regional anesthesia is particularly useful in operations on the lower abdomen, back, extremities, and superficial parts of the body and in obstetrics. It is assumed that the surgeon is experienced, skillful, and gentle and that he observes the basic principles of good surgical technique. To assure the patient of the best anesthetic care, both regional and general anesthetics must be available to the anesthesiologist, and he should be free to choose on the basis of their respective indications and limitations.