Abstract: In this updated version of the review, we found no new studies that met our inclusion criteria. We included in this review four studies that compared neuraxial anaesthesia with general anaesthesia. The total number of participants was 696, of whom 417 were allocated to neuraxial anaesthesia and 279 to general anaesthesia. Participants allocated to neuraxial anaesthesia had a mean age of 67 years, and 59% were men. Participants allocated to general anaesthesia had a mean age of 67 years, and 66% were men. Four studies had an unclear risk of bias. No difference was observed between participants allocated to neuraxial or general anaesthesia in mortality rate (OR 0.89, 95% CI 0.38 to 2.07; 696 participants; four trials), myocardial infarction (OR 1.23, 95% CI 0.56 to 2.70; 696 participants; four trials), and lower-limb amputation (OR 0.84, 95% CI 0.38 to 1.84; 465 participants; three trials). Pneumonia was less common after neuraxial anaesthesia than after general anaesthesia (OR 0.37, 95% CI 0.15 to 0.89; 201 participants; two trials). Evidence was insufficient for cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. Available evidence from included trials that compared neuraxial anaesthesia with general anaesthesia was insufficient to rule out clinically important differences for most clinical outcomes. Neuraxial anaesthesia may reduce pneumonia. No conclusions can be drawn with regard to mortality, myocardial infarction and rate of lower-limb amputation, or less common outcomes.

Plain-language summary: This systematic review is important because review authors assessed the risk of important outcomes after lower-limb revascularization with the participant under neuraxial or general anaesthesia. They performed this systematic review to answer a single research question: What are the rates of death and major complications with spinal and epidural anaesthesia as compared with other types of anaesthesia for lower-limb revascularization? In this second update of the Cochrane review, we searched the databases until April 2013 but found no new studies. The total number of participants in the four included studies was 696, of whom 417 received neuraxial anaesthesia and 279 received general anaesthesia. No evidence revealed differences in postoperative risk of death, myocardial infarction or leg amputation between the two types of anaesthetic. The risk of pneumonia was 9% after neuraxial anaesthesia and 20% after general anaesthesia. Evidence was insufficient to show the effects of neuraxial anaesthesia compared with other types of anaesthesia on cerebral stroke, duration of hospital stay, postoperative cognitive dysfunction, complications in the anaesthetic recovery room and transfusion requirements. No data described nerve dysfunction, postoperative wound infection, patient satisfaction, postoperative pain score, claudication distance and pain at rest. One study recruited more than 50% of all reported cases.This systematic review shows that neuraxial anaesthesia may reduce the risk of pneumonia after lower-limb revascularization, but evidence is insufficient to support other benefits or harms.