Purpose of review
Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia
and analgesia influence outcome
after vascular surgery.
Large database analyses of contemporary practice suggest that utilizing regional anesthesia
for both open and endovascular aortic aneurysm repair, lower limb revascularization and carotid endarterectomy reduces morbidity, length of stay and possibly even mortality. Results from such analyses are limited by an inherent risk of bias but are nevertheless important given the number of patients required in randomized trials to detect differences in rare outcomes. There is minimal evidence that regional anesthesia
influences longer term outcomes except for arteriovenous fistula surgery where brachial plexus blocks appear to improve 3-month fistula patency.
Patients undergoing vascular surgery often have multiple comorbidities and it is important to be able to outline both benefits and risks of regional anesthesia
techniques. Regional anesthesia
in vascular surgery allows avoidance of general anesthesia
and does provide short-term benefits beyond superior analgesia. Evidence of long-term benefits is lacking in most procedures. Further work is required on newer patient centered outcomes.