Anaesthesia in orthopaedic surgery

Regional anaesthesia (RA), general anaesthesia (GA), and RA integrated with mild GA (IA) are the options available to the anaesthetist in orthopaedic and traumatology surgery. Choosing the most appropriate anaesthetic depends on the anaesthetist’s habits and technical skills. Estimated bleeding, operation time, and postoperative pain and stress should be borne in mind, because of the physical and psychological repercussions they entail. The advantages of RA are the control of endocrine-metabolism reactions induced by surgical stress [1], [2], reduced perioperative bleeding [3], and reduced postoperative morbidity [1], [4]. GA provides sedation and protection from the surgical environment (noise, smells, emergencies) and enables the patients to stay in uncomfortable positions for a long time. However, it fails to inhibit hormonal and endocrine responses to stress, even with the help of high plasma concentrations of opioids [5], [6].