Clinical outcomes after lower extremity revascularization: a comparison of epidural and general anaesthesia

OBJECTIVE: This study tests the hypothesis that epidural anesthesia during, and epidural analgesia after, lower extremity vascular surgery decreases the incidence of postoperative morbidity compared with general anesthesia. METHOD: Using a prospective, randomized, non-blinded clinical trial design, 82 patients scheduled for lower extremity revascularization surgery were randomized to either epidural anesthesia and postoperative analgesia or general anesthesia and systemic opioid analgesia during and after surgery. Measurements were made of preoperative patient demographic data, intraoperative anesthetic management, and intra- and postoperative clinical outcomes including major organ system morbidity and vascular graft function. Patients in the two groups were similar before surgery. RESULTS: There were no significant differences in major organ system morbidity after surgery or in hospital length of stay. Patients randomized to the epidural group had a decreased incidence of early vascular graft failure at 7 days after surgery, a difference that was no longer significant by 30 days after surgery. CONCLUSIONS: Epidural anesthesia and analgesia decreased the incidence of early lower extremity vascular graft failure within 7 days of surgery.This favorable effect on graft function was no longer present 30 days after surgery.