Comparative Effectiveness Research on Spinal <i>versus</i> General Anesthesia for Surgery in Older Adults

Neuman, Mark D.; Sieber, Frederick E.; Dillane, Derek

doi:10.1097/aln.0000000000004604

Cited by 4 publications

(2 citation statements)

References 100 publications

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“…The advantages of epidural anesthesia compared to GA have been demonstrated, including better postoperative analgesia, reduced blood loss, better hemodynamic characteristics, reduced stress response, and lower medical costs. 6,25 However, we believe that LA is more convenient and time-saving, and allows for immediate postoperative neurological examination compared to epidural anesthesia. In addition, LA can avoid some specific complications of epidural anesthesia, such as total spinal anesthesia and postoperative urinary retention.…”

Section: Discussionmentioning

confidence: 96%

“…4 Additionally, the use of GA during these procedures poses a potential risk, especially for elderly patients with comorbidities. [5][6][7] As a result, awake spinal surgery (ASS), a new strategy combining minimally invasive techniques with conscious LA, is increasingly promoted. 8,9 Several studies have demonstrated the benefits of ASS in reducing complications and accelerating postoperative recovery.…”

Section: Introductionmentioning

confidence: 99%

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Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Wu,

Liu,

Meng

et al. 2024

CIA

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Purpose Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients. Patients and Methods This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system. Results UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41±1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores ( p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study. Conclusion Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Wu,

Liu,

Meng

et al. 2024

CIA

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Neuraxial Anesthesia and Risk of Root Damage: A 3D Ex Vivo Study

Labandeyra,

Sala-Blanch,

Prats-Galino

et al. 2024

NeuroSci

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Cauda equina nerve roots may become damaged during neuraxial anesthesia, and post-puncture headache may appear in the case of cerebrospinal fluid leakage if needle tips are deformed due to bone contact when several attempts are needed. Our aim was to verify the correlation between skin–transverse process distance (st) and skin–dural sac distance (d) for calculation of optimal angles in a free visual guide and as a reference for the maximal depth to be traversed by the needle. Randomly selected ex vivo samples (n = 10) were flexed to reproduce the position of the lumbosacral spine during spinal anesthesia. Spinal needles were inserted perpendicular to the skin either blindly or following the inferred paramedian angle corresponding to ultrasound-measured (d). After computed tomography and three-dimensional reconstruction, both (st) and (d) were measured, and the Pearson correlation index was calculated. A free 3D-PDF tool was used to illustrate the potential affectation of nerve cuffs by needles located lateral to the dural sac. Correlation between (d) and (st) was 0.84–0.93 at L4L5-L3L4 intervertebral levels, and most needle tips were located within the spinal canal, but some traversed the zone where nerve cuffs emerge. In conclusion, ultrasound may determine if a perpendicular needle insertion is viable at midline. If not, the optimal paramedian angle and maximal depth may be determined by measuring (st).

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Meta-analysis of the efficacy of the erector spinae plane block after spinal fusion surgery

He,

Liu,

et al. 2024

PeerJ

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Objective To investigate the efficacy of erector spinal plane block (ESPB) after spinal fusion surgery in this study. Methods The PubMed, Embase, Cochrane library, and Web of Science databases were searched with a search deadline of March 30, 2024, and Stata 15.0 was used to analyze the data from the included studies. Result Nine randomized controlled trials involving 663 patients were included. Meta-analysis showed that EPSB could reduce pain scores at 2h (standard mean difference (SMD) = −0.78, 95% CI [−1.38 to −0.19], GRADE: Moderate), 6 h (SMD = −0.81, 95% CI [−1.23 to −0.38], GRADE: Moderate), 12 h (SMD = −0.59, 95% CI [−1.05 to −0.13], GRADE: Moderate), 24 h (SMD = −0.54, 95% CI [−0.86 to −0.21], GRADE: Moderate), 48 h (SMD = −0.40, 95% CI [−0.75 to −0.05], GRADE: Moderate) after spinal fusion surgery, as well as the PCA (analgesia medication use) (SMD = −1.67, 95% CI [−2.67 to −0.67], GRADE: Moderate). However, EPSB had no effect on intraoperative blood loss (SMD = −0.28, 95% CI [−1.03 to 0.47], GRADE: Low) and length of hospital stay (SMD = −0.27, 95% CI [−0.60–0.06], GRADE: Low). Conclusion Combined with the current findings, EPSB may reduce pain scores in spinal fusion surgery, possibly reducing the use of postoperative analgesics. However, due to the limitations of the study, we need more high-quality, multi-center, large sample randomized controlled trials to merge.

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Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

Cited by 4 publications

References 100 publications

Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Neuraxial Anesthesia and Risk of Root Damage: A 3D Ex Vivo Study

Meta-analysis of the efficacy of the erector spinae plane block after spinal fusion surgery

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