Regional Anesthesia: A Narrative Review of Impact on Oxidative Stress Biomarkers

Abstract

Background/Objectives: Oxidative stress results from an imbalance between reactive oxygen species (ROS) production and antioxidant defenses and has been implicated in the pathogenesis of numerous diseases, including cardiovascular and neurodegenerative disorders. In the perioperative setting, both surgical trauma and anesthetic agents may contribute to oxidative stress. While this phenomenon has been extensively studied under general anesthesia, the role of regional anesthesia remains less defined. This review aims to compare the impact of general and regional anesthesia techniques on oxidative stress and its biomarkers across various surgical disciplines. Methods: A literature search was conducted using PubMed and EBSCO databases, focusing on studies published between 2010 and 2024. Search terms included "anesthesiology", "oxidative stress", "regional anesthesia", "general anesthesia", and related biomarkers (e.g., MDA, TAS, TOS, thiol/disulfide). Inclusion criteria required that studies compare general and regional anesthesia techniques and assess at least one biomarker of oxidative stress. Seventeen studies were included in the final analysis. Results: Findings were heterogeneous. Some studies reported that regional anesthesia, particularly spinal and peripheral nerve blocks, was associated with lower levels of malondialdehyde (MDA), reduced total oxidant status (TOS), and improved total antioxidant status (TAS), suggesting reduced oxidative stress. In contrast, other studies showed higher levels of oxidative stress markers under regional anesthesia or no significant differences between techniques. Outcomes varied by surgical type, biomarker used, patient population, and methodological quality. Conclusions: Current evidence is insufficient to establish definitive recommendations regarding the choice of anesthetic technique based on oxidative stress outcomes. However, regional anesthesia appears to be associated with a more favorable oxidative profile in some settings, such as cesarean section and selected orthopedic procedures. Further standardized, large-scale studies are needed to clarify these findings and guide anesthetic decision-making in the context of oxidative balance.

Keywords: anesthesiology; oxidative stress; oxidative stress biomarkers; regional anesthesia.