Neuraxial locoregional anesthesia should no longer be used in vascular surgery

Objectives: Neuraxial blockade (spinal or epidural anesthesia) is still wid ely used in patients undergoing vascular surgery, However, the combined adm inistration of anticoagulants and antiplatelet agents may compromise the sa fety of this technique with regards to the potential occurrence of a spinal or of an epidural hematoma. We review the benefits and risks of neuraxial blockade in light of the evolution of anticoagulation for vascular surgery. Main findings: Vascular surgery generally requires a high level of intraope rative anticoagulation. An increasing number of patients are also treated p re and post-operatively with antiplatelet agents. Their administration cann ot be interrupted without serious risks to the patients' cardiovascular sys tem and, further their continued use during surgery may improve graft perme ability. Recent reports have emphasized the danger of neuraxial anesthesia in patients receiving low dose anticoagulation. So, high doses of heparins should carry an ever higher risk of serious complications in patients under going neuraxial blockade. Furthermore, no published data has ever demonstra ted convincingly the benefit of either epidural or spinal anesthesia over g eneral anesthesia. No differences have ever been documented in terms of car dio-vascular morbidity, graft patency, and mortality, Conclusion: Routine neuraxial blockade cannot be recommended in patients un dergoing vascular surgery. The decision to perform a neuraxial block in suc h a patient may only be taken on a case by case basis, after careful consid eration of expected benefits and potential risks.