Advertisement

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis of Randomized and Non-Randomized Studies

  • Allen Li
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
    Search for articles by this author
  • Hannah Dreksler
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
    Search for articles by this author
  • Sudhir K. Nagpal
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
    Search for articles by this author
  • Timothy Brandys
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
    Search for articles by this author
  • Prasad Jetty
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
    Search for articles by this author
  • Luc Dubois
    Affiliations
    Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada

    Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada

    ICES, Ontario, Canada
    Search for articles by this author
  • Jeanna Parsons Leigh
    Affiliations
    School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
    Search for articles by this author
  • Henry T. Stelfox
    Affiliations
    Department of Critical Care Medicine, University of Calgary and Alberta Health Services

    O’Brien Institute for Public Health, University of Calgary
    Search for articles by this author
  • Daniel I. McIsaac
    Affiliations
    Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada

    ICES, Ontario, Canada

    Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada

    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    Search for articles by this author
  • Derek J. Roberts
    Correspondence
    Corresponding Author , Division of Vascular and Endovascular Surgery, Department of Surgery and School of Epidemiology and Public Health, University of Ottawa Associate Scientist, Clinical Epidemiology Program, The Ottawa Hospital Research Institute The Ottawa Hospital, Civic Campus Room A-280, 1053 Carling Avenue Ottawa, Ontario, Canada K1Y 4E9 Tel.: 613-798-5555, Ext. 16268 Fax: 613-761-5362
    Affiliations
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada

    O’Brien Institute for Public Health, University of Calgary

    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
    Search for articles by this author
Published:November 03, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.10.046
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      To determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia for lower limb revascularization surgery affects patient outcomes.

      Design

      Systematic review and meta-analysis.

      Methods

      After protocol registration, we searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews for randomized and non-randomized studies comparing neuraxial or regional anesthesia to general anesthesia for lower limb revascularization surgery in adults. Two investigators independently selected articles, extracted data, and assessed risks of bias. Data were pooled using random-effects models. We used GRADE to assess certainty in cumulative evidence.

      Results

      Among 10,755 citations identified, we included 5 randomized (n=970) and 13 non-randomized (n=96,800) studies. Use of neuraxial instead of general anesthesia for lower limb revascularization surgery was associated with no significant reduction in short-term (in-hospital or 30-day) mortality in randomized studies [pooled-odds ratio (OR)=0.77; 95% confidence interval (CI)=0.33-1.81; low certainty) and a significant reduction in adjusted short-term mortality in non-randomized studies (pooled-OR=0.67; 95% CI=0.56-0.81; low certainty). Adults allocated to neuraxial anesthesia in randomized studies had fewer pulmonary complications (pooled-OR=0.35; 95% CI=0.16-0.76; low certainty). In non-randomized studies, receipt of neuraxial instead of general anesthesia was associated with a lower adjusted odds of any morbidity (pooled-OR=0.66; 95% CI=0.52-0.84), cardiac complications (pooled-OR=0.68; 95% CI=0.58-0.79), pneumonia (pooled-OR=0.81; 95% CI=0.64-1.02), prolonged mechanical ventilation (OR=0.09; 95% CI=0.002-0.55), and bypass graft thrombosis (OR=0.70; 95% CI=0.59-0.85), as well as a shorter operative duration (low certainty for all). Use of a nerve block instead of general anesthesia was associated with a lower adjusted odds of delirium (OR=0.16; 95% CI=0.06-0.42) and a shorter operative duration (low certainty for both).

      Conclusions

      Randomized and non-randomized data suggest that use of neuraxial anesthesia for lower limb revascularization surgery reduces morbidity and possibly mortality. Until randomized trials with a low risk of bias become available, this study supports use of neuraxial anesthesia for these procedures where appropriate.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Vascular and Endovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect