{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:57:03Z","timestamp":1793411823536,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u201canesthesiology\u201d, \u201coxidative stress\u201d, \u201cregional anesthesia\u201d, \u201cgeneral anesthesia\u201d, 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.<\/jats:p>","DOI":"10.3390\/jcm14217503","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T09:44:30Z","timestamp":1761212670000},"page":"7503","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Regional Anesthesia: A Narrative Review of Impact on Oxidative Stress Biomarkers"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8359-6801","authenticated-orcid":false,"given":"Karolina","family":"Jaruga","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative Care and Pain Management Unit, Medical University of Bia\u0142ystok, 15-274 Bia\u0142ystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8526-8107","authenticated-orcid":false,"given":"Anna","family":"Pu\u015bcion-Jakubik","sequence":"additional","affiliation":[{"name":"Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Bia\u0142ystok, 15-222 Bia\u0142ystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5680-9146","authenticated-orcid":false,"given":"Piotr","family":"Jakub\u00f3w","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative Care and Pain Management Unit, Medical University of Bia\u0142ystok, 15-274 Bia\u0142ystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1089\/ars.2006.8.1865","article-title":"Redefining oxidative stress","volume":"8","author":"Jones","year":"2006","journal-title":"Antioxid. Redox Signal."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s12291-014-0446-0","article-title":"Free radicals: Properties, sources, targets, and their implication in various diseases","volume":"30","author":"Phaniendra","year":"2015","journal-title":"Indian J. Clin. Biochem."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1083\/jcb.201102095","article-title":"Signal transduction by reactive oxygen species","volume":"194","author":"Finkel","year":"2011","journal-title":"J. Cell Biol."},{"key":"ref_4","first-page":"2082145","article-title":"The Role of Oxidative Stress in Physiopathology and Pharmacological Treatment with Pro- and Antioxidant Properties in Chronic Diseases","volume":"2020","year":"2020","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Reddy, V.P. (2023). Oxidative Stress in Health and Disease. Biomedicines, 11.","DOI":"10.3390\/biomedicines11112925"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1266","DOI":"10.1097\/MD.0000000000001266","article-title":"Isoflurane and Propofol Contribute to Increasing the Antioxidant Status of Patients During Minor Elective Surgery: A Randomized Clinical Study","volume":"94","author":"Braz","year":"2015","journal-title":"Medicine"},{"key":"ref_7","first-page":"169","article-title":"Oxidative stress under general intravenous and inhalation anaesthesia","volume":"71","author":"Peraica","year":"2020","journal-title":"Arch. Ind. Hyg. Toxicol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"R146","DOI":"10.1186\/cc5068","article-title":"Oxidative stress is increased in critically ill patients according to antioxidant vitamins intake, independent of severity: A cohort study","volume":"10","author":"Aguayo","year":"2006","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8782387","DOI":"10.1155\/2021\/8782387","article-title":"Anesthesia-Induced Oxidative Stress: Are There Differences between Intravenous and Inhaled Anesthetics?","volume":"2021","author":"Senoner","year":"2021","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1213\/ANE.0b013e31822b8984","article-title":"Thoracic epidural bupivacaine attenuates inflammatory response, intestinal lipid peroxidation, oxidative injury, and mucosal apoptosis induced by mesenteric ischemia\/reperfusion","volume":"113","author":"Bedirli","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"644","DOI":"10.3906\/sag-2006-84","article-title":"Evaluation of saliva glutathione, glutathione peroxidase, and malondialdehyde levels in head-neck radiotherapy patients","volume":"51","year":"2021","journal-title":"Turk. J. Med Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00345-024-04843-3","article-title":"Combination of urinary biomarkers and machine-learning models provided a higher predictive accuracy to predict long-term treatment outcomes of patients with interstitial cystitis\/bladder pain syndrome","volume":"42","author":"Jhang","year":"2024","journal-title":"World J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1006\/abio.1998.3037","article-title":"An improved method for the measurement of urinary and plasma F2-isoprostanes using gas chromatography-mass spectrometry","volume":"268","author":"Mori","year":"1999","journal-title":"Anal. Biochem."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/0076-6879(90)86141-H","article-title":"Determination of carbonyl content in oxidatively modified proteins","volume":"186","author":"Levine","year":"1990","journal-title":"Methods Enzymol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0009-8981(03)00003-2","article-title":"Protein carbonyl groups as biomarkers of oxidative stress","volume":"329","author":"Rossi","year":"2003","journal-title":"Clin. Chim. Acta"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Poimenova, I.A., Sozarukova, M.M., Ratova, D.V., Nikitina, V.N., Khabibullin, V.R., Mikheev, I.V., Proskurnina, E.V., and Proskurnin, M.A. (2024). Analytical Methods for Assessing Thiol Antioxidants in Biological Fluids: A Review. Molecules, 29.","DOI":"10.3390\/molecules29184433"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"10978","DOI":"10.3390\/ijms241310978","article-title":"Total Antioxidant Capacity: Biochemical Aspects and Clinical Significance","volume":"24","author":"Silvestrini","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.clinbiochem.2003.11.015","article-title":"A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation","volume":"37","author":"Erel","year":"2004","journal-title":"Clin. Biochem."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.clinbiochem.2005.08.008","article-title":"A new automated colorimetric method for measuring total oxidant status","volume":"38","author":"Erel","year":"2005","journal-title":"Clin. Biochem."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4097\/kja.22366","article-title":"Single-shot regional anesthesia for laparoscopic cholecystectomies: A systematic review and network meta-analysis","volume":"76","author":"Sella","year":"2023","journal-title":"Korean J. Anesthesiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1007\/s00464-018-6083-6","article-title":"Laparoscopic total extraperitoneal hernia repair under regional anesthesia: A systematic review of the literature","volume":"32","author":"Baloyiannis","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_22","first-page":"239","article-title":"Does Post-Surgery Placement of Rectus Sheath Block Analgesia Alter the Oxidative Stress Biomarker 8-OHdG Concentrations: A Randomised Trial of Patients with Cancer and Benign Disease","volume":"13","author":"Purdy","year":"2016","journal-title":"Cancer Genom. Proteom."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"897","DOI":"10.21873\/anticanres.11396","article-title":"Does Rectus Sheath Block Analgesia Alter Levels of the Oxidative Stress Biomarker Glutathione Peroxidase: A Randomised Trial of Patients with Cancer and Benign Disease","volume":"37","author":"Purdy","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_24","first-page":"1003","article-title":"Patients with Increased Levels of the Oxidative Stress Biomarker SOD1 Appear to Have Diminished Postoperative Pain After Midline Laparotomy: A Randomised Trial with Special Reference to Postoperative Pain Score (NRS)","volume":"38","author":"Selander","year":"2018","journal-title":"Anticancer. Res."},{"key":"ref_25","first-page":"104","article-title":"Comparison of the effects of Anesthesia Methods on Dynamic Thiol\/Disulfide Homeostasis in Patients with Chronic Obstructive Pulmonary Disease Under Surgical Stress","volume":"8","year":"2024","journal-title":"Ahi Evran Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1007\/s00464-012-2536-5","article-title":"The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery","volume":"27","author":"Shin","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Greimel, F., Maderbacher, G., Baier, C., Keshmiri, A., Schwarz, T., Zeman, F., Meissner, W., Grifka, J., and Benditz, A. (2018). Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: General, regional and combination anesthesia in knee arthroplasty. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-22146-7"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ko\u015fucu, M., Co\u015fkun, I., Eroglu, A., Kutanis, D., Mente\u015fe, A., Karahan, S.C., Baki, E., Kerimo\u011flu, S., and Topbas, M. (2014). The effects of spinal, inhalation, and total intravenous anesthetic techniques on ischemia-reperfusion injury in arthroscopic knee surgery. BioMed Res. Int., 2014.","DOI":"10.1155\/2014\/846570"},{"key":"ref_29","first-page":"222","article-title":"The Effect of Spinal and General Anesthesia on Thiol-Disulfide Balance During Ischemia\/Reperfusion of the Leg in Patients Undergoing Knee Replacement Surgery","volume":"31","author":"Simsek","year":"2023","journal-title":"J. Anesth. \/Anestezi Derg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/j.freeradbiomed.2011.01.021","article-title":"Effects of spinal or general anesthesia on F2-isoprostanes and isofurans during ischemia\/reperfusion of the leg in patients undergoing knee replacement surgery","volume":"50","author":"Mas","year":"2011","journal-title":"Free. Radic. Biol. Med."},{"key":"ref_31","first-page":"312","article-title":"The Effect of Spinal and General Anesthesia on Serum Lipid Peroxides and Total Antioxidant Capacity in Diabetic Patients with Lower Limb Amputation Surgery","volume":"6","author":"Bameshki","year":"2018","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_32","first-page":"17","article-title":"Spinal and general anesthesia produces differential effects on oxidative stress and inflammatory cytokines in orthopedic patients","volume":"36","author":"Aremu","year":"2020","journal-title":"Drug Metab. Pers. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e40549","DOI":"10.1097\/MD.0000000000040549","article-title":"Ultrasound-guided femoral nerve block reduced the incidence of postoperative delirium after total knee arthroplasty: A double-blind, randomized study","volume":"103","author":"Zhao","year":"2024","journal-title":"Medicine"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Alleva, R., Togn\u00f9, A., Tomasetti, M., Benassi, M.S., Pazzaglia, L., van Oven, H., Vigan\u00f2, E., De Simone, N., Pacini, I., and Giannone, S. (2019). Effect of different anaesthetic techniques on gene expression profiles in patients who underwent hip arthroplasty. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0219113"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e14948","DOI":"10.1111\/ijcp.14948","article-title":"Effects of general anaesthesia and ultrasonography-guided interscalene block on pain and oxidative stress in shoulder arthroscopy: A randomised trial","volume":"75","author":"Oksuz","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"510","DOI":"10.14744\/tjtes.2024.63534","article-title":"Comparison of the effects of axillary brachial plexus block, inhalation anesthesia, and total intravenous anesthesia on tourniquet-induced ischemia-reperfusion injury in upper extremity surgery","volume":"30","author":"Kutanis","year":"2024","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"659","DOI":"10.2298\/VSP1008659B","article-title":"The effects of different anesthesia techniques on free radical production after tourniquet-induced ischemia-reperfusion injury at children\u2019s age","volume":"67","year":"2010","journal-title":"Vojnosanit. Pregl."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S137","DOI":"10.33549\/physiolres.932170","article-title":"Biomarkers of oxidative stress and endothelial dysfunction after tourniquet release in children","volume":"60","author":"Budic","year":"2011","journal-title":"Physiol. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2519669","DOI":"10.1080\/07853890.2025.2519669","article-title":"Effect of regional nerve block on tourniquet-related injury in pediatric patients undergoing lower limb surgery: A randomized controlled study","volume":"57","author":"Xia","year":"2025","journal-title":"Ann. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Shi, X., Xu, C., Wen, Y., Jiang, M., Yu, H., Wang, X., Yuan, H., and Feng, S. (2024). Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: A seven-year retrospective analysis. BMC Anesthesiol., 24.","DOI":"10.1186\/s12871-024-02412-0"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"49","DOI":"10.17085\/apm.20072","article-title":"Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: A retrospective cohort study","volume":"16","author":"Sung","year":"2021","journal-title":"Anesth. Pain Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"739","DOI":"10.4103\/1735-1995.168373","article-title":"Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections","volume":"20","author":"Keskin","year":"2015","journal-title":"J. Res. Med Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"396","DOI":"10.35975\/apic.v27i3.2244","article-title":"Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections","volume":"27","author":"Karam","year":"2023","journal-title":"Anaesth. Pain Intensiv. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.23736\/S0375-9393.19.13598-5","article-title":"Effects of the anesthesia technique used during cesarean section on maternal-neonatal thiol disulfide homeostasis","volume":"85","author":"Akin","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"475","DOI":"10.4103\/0970-9185.74588","article-title":"Respiratory changes during spinal anaesthesia for gynaecological laparoscopic surgery","volume":"26","author":"Pusapati","year":"2010","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4274\/tjod.galenos.2020.28928","article-title":"Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study","volume":"17","author":"Pirbudak","year":"2020","journal-title":"J. Turk. Soc. Obstet. Gynecol."},{"key":"ref_47","first-page":"92","article-title":"Comparison of the Effects of Inhalation and Spinal Anesthesia on Microcirculation in Transverse Rectus Abdominis and Gluteus Maximus Muscle-Skin Flap Applications in Experimental Rat Models","volume":"7","author":"Bozkurt","year":"2022","journal-title":"Gevher Nesibe J. Med. Health Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"117349","DOI":"10.1016\/j.taap.2025.117349","article-title":"Impact of spinal anesthesia on myocardial damage, ultrastructure and cellular mechanisms in rats undergoing thoracic incision surgery","volume":"499","author":"Liu","year":"2025","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/j.pain.0000000000002670","article-title":"Perioperative oxidative stress predicts subsequent pain-related outcomes in the 6 months after total knee arthroplasty","volume":"164","author":"Bruehl","year":"2023","journal-title":"Pain"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5761\/atcs.oa.17-00127","article-title":"Association of Perioperative Redox Balance on Long-Term Outcome in Patients Undergoing Lung Resection","volume":"24","author":"Araki","year":"2018","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1093\/icvts\/ivx178","article-title":"The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: A meta-analysis","volume":"25","author":"Geng","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"108658","DOI":"10.1016\/j.ejso.2024.108658","article-title":"Risk stratification models incorporating oxidative stress factors to predict survival and recurrence in patients with gastric cancer after radical gastrectomy: A real-world multicenter study","volume":"50","author":"Zheng","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1213\/ANE.0000000000004455","article-title":"Perioperative Oxidative Stress: The Unseen Enemy","volume":"129","author":"Stevens","year":"2019","journal-title":"Anesth. Analg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7503\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T10:04:55Z","timestamp":1761213895000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":53,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217503"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217503","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]}}}