Regional analgesia in surgery - The surgeon's view

The last decades' development of modern equine surgery has resulted in highly advanced surgical procedures. Although both anaesthesia and surgery have progressed concomitantly with a focus on balanced anaesthesia, multimodal analgesia and minimally invasive surgery, some of the procedures performed may inevitably cause trauma and pain resulting in challenges for the anaesthetist. Particularly in human surgery, there is a move towards more procedures being performed completely under regional anaesthesia to reduce the risks of general anaesthesia (GA). In small animal surgery, the benefits of providing more local analgesia to patients under GA are being increasingly recognised. In equine surgery, there has definitively been a trend towards more procedures being performed standing, under sedation combined with loco-regional analgesia. For obvious reasons however, not all procedures and patients are suitable for standing surgery. Restricted access, safety of the surgeon and/or equipment etc. may still require surgery to be performed under GA. To reduce the negative effects and risks of GA, the anaesthetist often finds advantages in supplementing GA with loco-regional analgesic techniques. However, it still seems as if many surgeons have a reluctance to use local analgesia for horses under GA. This reluctance may in part be based on ignorance of the relevance of local analgesia for patient comfort intra- and postoperatively, but may mainly result from potentially relevant concerns for adverse effects that local analgesia may cause. [...]