Regional Anaesthesia Techniques for Orthopaedic Surgery: A Systematic Review

Abstract

Background: Regional anaesthesia has increasingly replaced general anaesthesia as the preferred technique for orthopaedic surgical procedures due to its superior postoperative analgesia, reduced opioid consumption, and favourable safety profile. This systematic review evaluates the efficacy, safety, and clinical outcomes of various regional anaesthesia techniques in orthopaedic surgery during the period 2016–2018.

Methods: A systematic search of PubMed, Cochrane Library, MEDLINE, and EMBASE databases was conducted. A total of 65 studies meeting inclusion criteria were reviewed. Patients undergoing lower limb, upper limb, and spinal orthopaedic procedures under various regional anaesthesia modalities were included. Outcomes assessed included postoperative pain scores, opioid consumption, block duration, onset time, complications, and patient satisfaction.

Results: Among 65 included studies (n = 4,280 patients), ultrasound-guided nerve blocks demonstrated superior block success rates (94.6%) compared to landmark-based techniques (81.2%). Spinal anaesthesia remained the gold standard for lower limb surgeries with a complication rate of 3.1%. Peripheral nerve blocks showed significantly reduced opioid consumption (mean reduction 58.4%) and shorter hospital stays. Complications were predominantly minor and included transient neurological symptoms (2.3%) and hypotension (5.8%).

Conclusion: Regional anaesthesia techniques, particularly ultrasound-guided peripheral nerve blocks and neuraxial anaesthesia, offer significant advantages in orthopaedic surgery with excellent efficacy and acceptable safety profiles. Multimodal analgesia incorporating regional techniques should be considered as first-line anaesthetic management for orthopaedic procedures.