Use of sedation techniques during local and regional anaesthesia

Abstract

Local anaesthetic techniques are increasing in popularity because of the improved recovery profiles compared with general and regional anaesthesia (Table II). The use of intravenous adjuvants during local and regional anaesthesia can provide enhanced patient comfort while optimizing intraoperative conditions. These sedativeanalgesic techniques may also be applied to procedures in which local anaesthetics are either unnecessary or impractical. While local anaesthetic-based regimens are generally perceived as safer than general anaesthesia, the addition of potent sedative-hypnotic and analgesic drugs may result in severe depression of central respiratory drive and/or transient upper airway obstruction. Although the use of carefully titrated infusions of rapid and short-acting sedative drugs should enhance patient safety, further studies are needed to determine the optimal delivery system for intravenous adjuvants. To achieve the desired results there is a need for vigilant monitoring, combined with supplemental oxygen administration and the availability of resuscitation equipment. Concerns regarding the increasing cost of health care has necessitated a careful examination of the cost-benefit of all newer sedative-analgesic drugs and techniques. Recently, Kain et al. reported that propofol was actually more cost-effective than inexpensive barbiturate drugs when used for sedation outside the operating room because of its more favourable recovery profile. In conclusion, the availability of newer sedative and analgesic drugs with more specific actions, shorter durations of action and reduced side effects, as well as newer techniques like PCS, should improve patient safety and comfort during local and regional anaesthesia in the future. © 1995 Canadian Anesthesiologists.