Bypassing arterial vascular obstruction in the legs is a surgical procedure in which the blood flow is improved in order to reduce leg pain and sometimes also to improve function. Usually the procedure is performed either with the patient unconscious under general anaesthesia or awake but with the legs numbed by giving an injection of local anaesthetic around the spinal cord in the back (spinal anaesthetic) or around the spinal cord in the area where the nerves from the legs join (epidural anaesthesia). A combination of general anaesthesia and neuraxial anaesthesia can also be used. Other types of anaesthesia that numb the lower limbs are less commonly used. This systematic review assessed the risk of important outcomes following lower-limb revascularization either under neuraxial anaesthesia or general anaesthesia. The total number of participants in the four included studies was 696, of whom 417 received neuraxial anaesthesia and 279 received general anaesthesia. There was no evidence of differences in the postoperative risks of death, myocardial infarction or leg amputation between the two types of anaesthetic. The risk of pneumonia was less after neuraxial anaesthesia in the studies which reported this outcome.
This systematic review shows that neuraxial anaesthesia may reduce the risk of pneumonia after lower-limb revascularization but there is insufficient evidence to support other benefits or harms.