Functional outcome after major orthopedic surgery:  the role of regional anesthesia redefined.
OBJECTIVE
Regional anesthesia can provide optimal pain management and stress reduction. This article aims to establish the impact of regional anesthesia in facilitating the recovery process, measured by significant clinical outcomes.


RESULTS
The most common outcome assessing the effectiveness of regional anesthesia following major orthopedic procedures has been pain intensity. In recent literature, more precise outcome measures of disability and related to patient's quality of life and ability to return to daily activities have been introduced. Those found in the period of this review and discussed in this article are maximum voluntary isovolumetric contraction, range of motion, walking tests, time up and go, cumulated ambulation score, stair climb test, Short Musculoskeletal Function Assessment, Western Ontario McMaster Osteoarthritis Index, constant Murley score, Knee Society evaluation, Community Health Activities Model Program for Seniors, Short Form 12 and 16. Performance based outcomes have been found to correlate poorly with self-reported outcomes after knee arthroplasty.


CONCLUSIONS
In order to establish the role of regional anesthesia in functional outcome after major orthopedic surgery, assessment of pain control is no longer sufficient. New clinically relevant outcomes must be introduced and used for procedure-specific studies.
Anesthesia Department, Montreal General Hospital, McGill University, Montreal, Canada.
Francisca
F
Bernucci
Francesco
F
Carli
D000203:Activities of Daily Living; D000368:Aged; D000765:Anesthesia, Conduction; D006801:Humans; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology