Pathophysiological cmd economic aspects of regional anaestesia

Increasing economic pressure and limited budgets in our health care system raise the question of cost effectiveness of various anaesthetic techniques, Regional anaesthetics are safe and very effective methods of pain relief. Economic analyses have to consider the quantification of costs in relation to the results (outcome) of different anaesthetics. Since the major part of total costs are wages (70%) in the anaesthesiology department, higher savi ngs can only be achieved by effective personnel management. While the mater ial costs (medical products and drugs) used for general anaesthesia exceed those for regional anaesthetics, the overall costs do not differ significan tly when an anaesthesiologist performs and completely surveys either anaest hetic. To compare cost effectiveness of different anaesthetic techniques, t he outcome in terms of cardiovascular, pulmonary or thrombotic complication s has to be assessed. Furthermore, the need of mechanical ventilation and t he length of stay in cost intensive units (ICU, PACU) has to be taken into account. In the last decade, numerous studies demonstrate protective effect s of epidural anaesthesia (EPA) on the perioperative stress response. In co mparison,vith general anaesthesia, EPA was associated with higher postopera tive vigilance levels, improved lung function and gastrointestinal motility as well as reduced risk of thrombotic and cardiovascular complications, On e of the major advantages is the highly efficient pain relief via epidural catheter, Disadvantages include potential ineffectiveness of peripheral or epidural blockades which require additional anaesthesia and might be more t ime consuming. In view of economic aspects, recent data point towards advan tageous effects of regional techniques compared with general anaesthesia du e to reduced perioperative morbidity and mortality which may lower costs ba sed on reduced hospital stay, especially in cost intensive units.