Local Versus General Anesthesia for Endovascular Repair of Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis.

BACKGROUND

Endovascular aneurysm repair (EVAR) has become increasingly popular compared with open repair due to its minimally invasive approach for treating abdominal aortic aneurysms (AAAs). However, the ideal anesthetic choice for patients undergoing EVAR remains debated. While some advocate for local anesthesia (LA), others believe that general anesthesia (GA) offers certain advantages.

OBJECTIVE

To compare LA with GA in patients undergoing EVAR.

METHODS

A search was conducted in the PubMed, Scopus, Embase, and Cochrane databases, focusing on studies that compared postoperative outcomes. Data were pooled using fixed- or random-effects models, and results are given in mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was calculated using the I statistic. All statistical analyses were performed using R software.

RESULTS

A total of 16 studies were included, comprising 45,566 patients. LA was associated with a decline in total hospital stay (MD: -1.00 day, 95% CI: -1.38 to -0.63, p < 0.01), myocardial infarction (OR: 0.52, 95% CI: 0.29 to 0.93, p = 0.02), and pneumonia (OR: 0.25, 95% CI: 0.11 to 0.55, p < 0.01). The LA group had an insignificant association with lower incidence of mortality (OR: 0.85, 95% CI: 0.64 to 1.13, p = 0.26) and in intensive care unit length of stay (MD: -0.20 day, 95% CI: -0.47 to 0.07, p = 0.14).

CONCLUSION

These results indicate that patients treated with LA are likely to be discharged more quickly and experience fewer adverse events.