Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> In this case-controlled study the authors analyzed outcomes obtained in 400 patients in whom either spinal anesthesia or general anesthesia was induced to perform a lumbar decompression. Patients were matched for anesthesia-related class, preoperative diagnosis, surgical procedure, and perioperative protocols. All aspects of surgery, recovery, postanesthesia care, and pain management were uniform irrespective of the anesthetic type. Case complexity was equivalent. An independent observer performed analysis of the data. Data from the intraoperative period through hospital discharge were collected and compared.</jats:p> <jats:p content-type="fine-print">Two hundred consecutive patients meeting inclusion criteria were included in each group. Patients were treated for either lumbar stenosis or herniated nucleus pulposus. Demographically, both groups were well matched. Anesthetic and operative times were longer for patients receiving a general anesthetic (p &lt; 0.05), in whom more nausea and greater requirements for antiemetics and pain medication were also present during recovery (p &lt; 0.05). Overall complication rates and, specifically, the incidences of urinary retention were significantly lower in spinal anesthesia—induced patients (p &lt; 0.05). There were no neural injuries in either group, and the incidence of spinal headache was lower in patients receiving a spinal anesthetic (1.5% compared with 3%).</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.</jats:p>

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

“…45,64 In contrast, studies in which either intrathecal fentanyl or sufentanil was utilized reported lower incidence rates ranging from 0 to 25%. 12,16,18,46,48,57,61 Kamphuis et al…”

Comparison of general vs regional anaesthesia for BM harvesting: a retrospective study of anaesthesia-related complications

“…Similar findings have been reported by others while comparing GA with RA for BMH, as well as for another surgical procedures. 6,7,11,13,14 In an earlier retrospective study of 162 BM donations (63 allogeneic and 99 autologous), Lavi et al 4 found that patients who underwent GA required more RBC units than those undergoing RA. Our results do not confirm this finding.…”

“…However, as known from other patient groups, one might expect some important differences in outcome depending on anaesthesia method. 8,[12][13][14] Available data suggest reduced mortality and morbidity among patients undergoing surgical procedures under RA. On the other hand, as a result of progress in SCT techniques and supportive care in recent years, there is a tendency to raise the age limit for BM donors.…”

“…These benefits include (1) reduced blood loss intra-operatively because of decreasing peripheral venous pressure; (2) patients' ability to change the position of arms, legs and chest, as needed to avoid nerve injury, brachial plexus palsy or pressure necrosis in either the face or chest wall; (3) reduced incidence of nausea and vomiting postoperatively; (4) better postoperative analgesia; (5) decreased stress response; (6) preservation of immune response; (7) shorter hospitalisation time; as well as (8) cost reduction. 5,6,7,8,[9][10][11][12][13][14] These benefits of RA should counterbalance the risk of respiratory complications (including respiratory depression) in a sedated pronepositioned patient when compared with GA (with a secured airway). 14 Spinal and anorectal surgery are the procedures carried out in the same body position as that for BMH (the prone position).…”

“…5,6,7,8,[9][10][11][12][13][14] These benefits of RA should counterbalance the risk of respiratory complications (including respiratory depression) in a sedated pronepositioned patient when compared with GA (with a secured airway). 14 Spinal and anorectal surgery are the procedures carried out in the same body position as that for BMH (the prone position). However, studies on the choice of anaesthesia for anorectal surgery include many less patients than those for spinal surgery.…”