Improved needle catheter technology, successful placement by nerve stimulation technique, recent introduction of long acting local anaesthetic agent, variety of opioid and non-opioid adjuvants to local anaesthetics, development of local anaesthetic encapsulated in lipophilic membrane, allowing for sustained release, have improved the success rates with neuraxial anaesthesia.
Spinal anaesthesia provides excellent surgical conditions for most orthopaedic surgeries on lower limbs, gynaecological, urological, perirectal and inguinal procedures.
Regional anaesthesia provides an awake patient which helps in early detection of complications eg: stroke in carotid endarterectomy, TURP syndrome in TURP patients.
Obesity and COPD are two challenging conditions to the anaesthesiologist. In patients with COPD- deleterious effects of general anaesthesia are worsening of V/Q ratio, attenuation of HPV, exacerbated bronchospasm along with sedative effects of general anaesthetics and opioids which increase the intraoperative and post operative pulmonary complications. For minor intermediate surgical procedures in patients with anticipated difficult airway it is safer wherever possible, to choose peripheral nerve block. A number of regional anaesthetic techniques can be used for day care surgeries. These techniques involves little physiological trespassing compared to GA, so they are particularly suited for ever growing population of high risk elderly patients presenting for day care procedures. In ambulatory orthopaedic surgery, regional anaesthesia techniques are utilized extensively. It provides excellent analgesia with reduced risk of opioid side effects such as nausea, vomiting, drowsiness In relation of site of surgery, upper limb nerves can be blocked with various techniques. A combined block of lower extremity offers many advantages over spinal / epidural