Local Anesthesia/Peripheral Nerve Block with Monitored Anesthesia Care (LPMAC) for Peripheral Vascular Surgery: Review Article

1. Abstract
Chronic limb threatening ischemia (CLTI) is associated with high morbidity and mortality. The 5 year survival for patients with CLTI is 50 - 60%, with 1 year perioperative mortality rate as high as 17-25%. General and regional anesthesia techniques have both been used successfully for patients with CLTI requiring endovascular revascularization interventions, open surgical bypass surgery and major lower limb amputations, however current evidence is insufficient to favour one technique over the other in terms of mortality and cardiac morbidity benefits. This article discusses the utility of Local anesthesia/Peripheral nerve block with monitored anesthesia care in lower extremity endovascular revascularization (LER) with a description of the commonly performed lower limb nerve blockades. It discusses the techniques, distribution of
anesthesia, the advantages and disadvantages of these nerve blocks and touches on the minimum peri-procedural monitoring required and what to watch out for in case of local anesthetic toxicity.