Regional anesthesia for peripheral vascular surgery: what does the evidence tell us?

PURPOSE OF THE REVIEW: Regional anesthesia is valuable in peripheral vascular surgery, either as the primary anesthetic or as an adjuvant to general anesthesia. Patients presenting for vascular surgery often have associated comorbidities that increase their risk of complications. Beyond benefits with superior pain control, regional anesthesia techniques have the potential to impact other outcomes.

RECENT FINDINGS: The majority of available evidence continues to be retrospective in nature. On the basis of the results of large data registries and meta-analyses, the use of regional anesthetics for peripheral vascular surgery, including revascularization, arteriovenous fistula creation, and amputations, leads to reduced risk of cardiopulmonary complications, shorter lengths of stay, reduced mortality, and higher patency rates of arteriovenous access at 1 year. Some of these effects are more likely in patients with significant underlying comorbidities.

SUMMARY: There is low-to-moderate evidence of improved outcomes with regional anesthetic techniques for peripheral vascular surgery. In spite of it, most patients receive general anesthesia. Recent retrospective studies have challenged the beneficial effect of regional anesthesia on certain outcomes; however, their inherent methodology limitations prevent us from drawing definite conclusions. Institutional culture and expertise likely play a significant role in the utilization of regional anesthesia.