Is local anaesthesia superior to general anaesthesia in endovascular repair of abdominal aortic aneurysm?

A best evidence topic in cardiovascular surgery was written in accordance to a structured protocol. The question addressed was: in patients undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is local anaesthetic (LA) superior to general anaesthetic in terms of perioperative outcomes? Altogether, 630 publications were found using the reported search protocol, of which 3 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and primary outcomes were tabulated. The 3 included studies are systematic reviews with meta-analyses, with no randomized trials identified. Within the studies, there is a degree of heterogeneity in terms of surgical case-mix (elective or emergency EVAR or both) and anaesthetic technique (LA, regional anaesthetic, local-regional anaesthetic and general anaesthetic). With 1 study not providing pooled estimates, the second study demonstrated statistical significance in favour of local-regional anaesthetic within the elective setting in terms of mortality [pooled odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52-0.95; P = 0.02], morbidity (pooled OR 0.73, 95% CI 0.55-0.96; P = 0.0006) and total length of hospital admission (pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P= 0.00001). The third study failed to demonstrate a statistically significant mortality benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P= 0.211). While the results of these studies fail to provide a clear answer to a complex surgical problem, it would be appropriate, in the light of current evidence, to recommend LA as non-inferior to general anaesthetic in both emergency and elective settings.