A Systematic Review and Meta-Analysis of Neuroaxial Versus General Anaesthesia for Revascularisation of Critical Limb Ischaemia

Objective: Lower limb revascularisation is associated with high rates of peri-operative morbidity and mortality. Procedures can be conducted under neuraxial anaesthesia (NA) or general anaesthesia (GA). A meta-analysis was conducted to investigate whether one anaesthetic modality was associated with superior outcomes for adults undergoing lower limb revascularisation. Methods: Electronic databases were searched for randomised and non-randomised studies comparing NA and GA for endovascular and or open revascularisation of critical limb ischaemia. The primary outcome was 30-day mortality and secondary outcomes included major adverse cardiovascular events (MACE), early graft thrombosis, and limb loss at one year. Statistical analysis comprised odds ratios and standardised mean differences using random effects models. Results: Nine studies involving 7 624 patients met the inclusion criteria. Meta-analysis of parameters did not show any statistically significant differences in rates of 30-day mortality (OR 1.15, 95% CI 0.82 1.62, p = .41), early graft thrombosis (OR 0.97, 95% CI 0.70 1.35, p = .88), limb loss at one year (OR 0.80, 95% CI 0.59 1.07, p = .13), and in rate of MACE (OR 0.80, 95% CI 0.54 1.17, p = .24), although clinical heterogeneity was present in the latter. There was a statistically significant difference in rates of pneumonia (OR 0.59, 95% CI 0.37 0.94). Conclusion: Considering the variety of study types included in this systematic review, a multicentre randomised control trial is warranted to further explore the difference between these two anaesthetic approaches, if present.