A Novel Anesthetic Technique for PEVAR

Area of Science:

• Vascular Surgery
• Anesthesiology
• Outpatient Procedures

Background:

• Percutaneous endovascular aneurysm repair (PEVAR) is advancing with smaller device profiles.
• General anesthesia is still common for PEVAR, despite its invasiveness.
• Anesthetic techniques have not kept pace with PEVAR's minimally invasive evolution.

Purpose of the Study:

• To introduce and evaluate a novel anesthetic technique for PEVAR in an outpatient setting.
• To assess the safety, efficacy, and cost-effectiveness of this new approach.
• To determine if general anesthesia can be avoided for PEVAR patients.

Main Methods:

• Six patients undergoing PEVAR in an outpatient setting received moderate intravenous sedation (versed and fentanyl).
• Bilateral ilioinguinal nerve blocks with 0.5% bupivacaine with epinephrine were administered.
• Patients were monitored noninvasively, with an anesthesiologist present throughout.

Main Results:

• All PEVAR procedures were successful.
• Anesthetic supply costs averaged approximately $7.00 per case.
• No patients required conversion to general anesthesia, and postoperative pain was well-managed.

Conclusions:

• Bilateral ilioinguinal nerve blocks plus moderate IV sedation provide excellent anesthesia for PEVAR.
• This technique is safe, effective, and significantly more cost-effective than general anesthesia.
• It reduces physiological insult and potentially cognitive effects associated with general anesthesia.