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Macfarlane AJR, Vlassakov K, Elkassabany N. Regional anesthesia for vascular surgery: does the anesthetic choice influence outcome? Curr Opin Anaesthesiol 2019; 32:690-6. [PMID: 31415047 DOI: 10.1097/ACO.0000000000000781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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. RECENT FINDINGS 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. SUMMARY 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.
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Armstrong RA, Squire YG, Rogers CA, Hinchliffe RJ, Mouton R. Type of Anesthesia for Endovascular Abdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2019; 33:462-471. [DOI: 10.1053/j.jvca.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/13/2022]
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Hajibandeh S, Hajibandeh S, Adasonla K, Antoniou SA, Barrie J, Madan M, Antoniou GA. Loco-regional versus general anaesthesia for elective endovascular aneurysm repair – results of a cohort study and a meta-analysis. VASA 2018; 47:209-217. [DOI: 10.1024/0301-1526/a000688] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: The aim of this study was to investigate whether patients undergoing elective endovascular aneurysm repair (EVAR) with loco-regional anaesthetic techniques have better outcomes than those treated with general anaesthesia (GA). Patients and methods: We retrospectively evaluated outcomes of EVAR performed with regional anaesthesia (RA) or GA over a five-year period. Furthermore, we searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) to identify studies comparing different anaesthetic methods in EVAR. We defined perioperative mortality and morbidity as well as length of hospital stay (LOS) as the primary outcome measures. Pooled effect estimates were calculated using fixed-effect or random-effects models. Results are reported as the odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). Results: Three hundred and fifty-five patients underwent standard EVAR over the study period (RA, 215 patients; GA 140 patients). Patients in both groups had comparable baseline demographics and clinical characteristics. Perioperative mortality was significantly lower in the RA group (0.5 % vs. 4.3 %, P = 0.017). No difference was found in perioperative morbidity (P = 0.370), LOS (P = 0.146), postoperative destination (P = 0.799), reoperation (P = 0.355) or readmission within 30 days (P = 0.846). Meta-analysis of data on 15,472 patients from 15 observational studies found a significantly lower perioperative mortality (OR 0.70, 95 % CI 0.52–0.95, P = 0.02) and morbidity (OR 0.73, 95 % CI 0.55–0.96, P = 0.02) in patients treated with loco-regional anaesthetic techniques compared to those treated with GA. Our sub-group analysis demonstrated that both local anaesthesia (LA) (P = 0.003) and RA (P < 0.0001) were associated with a significantly shorter LOS compared to GA. Conclusions: Local and/or regional anaesthetic techniques may be advantageous over GA in elective EVAR, as indicated by reduced perioperative mortality and morbidity and a shorter hospital stay. Considering the current level of evidence, LA or RA should be considered in selected patients. Further clinical research is required to provide high level evidence on the optimal anaesthetic technique in EVAR.
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Affiliation(s)
- Shahin Hajibandeh
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
- These authors contributed equally to this paper
| | - Shahab Hajibandeh
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
- These authors contributed equally to this paper
| | - Kelvin Adasonla
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Stavros A. Antoniou
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Janet Barrie
- Department of Anaesthesia, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Manmohan Madan
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - George A. Antoniou
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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Muñoz LA, Reyes LE, Camargo RE, Rodríguez MA, Romero EA, Niño CG. Técnica anestésica para reparo endovascular de aneurisma de aorta abdominal. Repertorio de Medicina y Cirugía 2017; 26:144-51. [DOI: 10.1016/j.reper.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lalla R, Koteswara C, Ananth S. Unilateral laparotomy under paravertebral block in a desperate situation. Indian J Anaesth 2014; 58:86-7. [PMID: 24700913 PMCID: PMC3968667 DOI: 10.4103/0019-5049.126839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Spiček-Macan J, Stančić-Rokotov D, Hodoba N, Kolarić N, Cesarec V, Pavlović L. Thoracic paravertebral nerve block as the sole anesthetic for an open biopsy of a large anterior mediastinal mass. J Cardiothorac Vasc Anesth 2013; 28:1032-9. [PMID: 24035063 DOI: 10.1053/j.jvca.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jasna Spiček-Macan
- Department of Anesthesiology, Reanimatology, and Intensive Care, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia.
| | - Dinko Stančić-Rokotov
- Department of Thoracic Surgery, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia
| | - Nevenka Hodoba
- Department of Anesthesiology, Reanimatology, and Intensive Care, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia
| | - Nevenka Kolarić
- Department of Anesthesiology, Reanimatology, and Intensive Care, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia
| | - Vedran Cesarec
- Department of Thoracic Surgery, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia
| | - Ladislav Pavlović
- Department of Pulmonology, University Hospital Centre Zagreb, Jordanovac 104, Zagreb, Croatia
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Karthikesalingam A, Thrumurthy SG, Young EL, Hinchliffe RJ, Holt PJ, Thompson MM. Locoregional anesthesia for endovascular aneurysm repair. J Vasc Surg 2012; 56:510-9. [DOI: 10.1016/j.jvs.2012.02.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/14/2012] [Accepted: 02/19/2012] [Indexed: 11/15/2022]
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Abstract
PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.
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