Regional Anesthesia and Postoperative Pain Management

THERE has been unquestionably renewed interest in regional anesthesia, or perhaps more correctly, "regional analgesia," which helps build interest in perioperative pain medicine. With the current improvements in both intraoperative general and regional anesthesia, it is unlikely that for unselected groups of patients, differences in outcome will be found for the intraoperative interval. Nevertheless, if advances in regional anesthesia are to continue to add value to our surgical patients, and if regional methods are to become more widely accepted by anesthesiologists, surgeons, patients, and admiriistrators, more work is needed to prove that such techniques really offer measurable advantages over other methods that are perceived to be "easier," faster, and less dependent on specific technical skills, such as general anesthesia or postoperative patient-controlled analgesia. Furthermore, despite humanitarian concerns about minimizing pain in all of our patients-and we realize that this statement may be viewed as offensive to some-in this era of managed care and cost containment, the demonstrated "advantages" probably need to go beyond simply showing that pain assessment scores are improved or that less morphine is needed by patients. Without such concrete information on benefits, it becomes more difficult to introduce effectively the analgesic methods, particularly in the face of concerns about rare but severe complications ( e g . , neuraxial hematomas associated with enoxaparin).