Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis

Walcott, Brian P.; Khanna, Arjun; Yanamadala, Vijay; Coumans, Jean Valery; Peterfreund, Robert A.

doi:10.1016/j.jocn.2014.08.024

Cited by 28 publications

(34 citation statements)

References 19 publications

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“…The finding of a lower incidence of intra‐operative hypertension and tachycardia with spinal anaesthesia concurs with previous non‐randomised studies . This may be attributable variously to pharmacological sympatholysis , profound surgical analgesia , reduced stress response and the avoidance of endotracheal instrumentation . In terms of hypotension and bradycardia, a previous retrospective analysis of 803 patients concluded that spinal anaesthesia is associated with milder hypotension and bradycardia than general anaesthesia in elective lumbar spine operations ; however, our meta‐analysis does not corroborate this finding.…”

Section: Discussionsupporting

confidence: 76%

“…The use of regional anaesthesia is not widely accepted because: it might interfere with neurological assessment in the postoperative period; it might conceal a surgical haematoma; the anaesthetist might be blamed for a surgery‐related nerve injury; and it cannot be used in lengthy and extensive procedures. However, growing evidence has emerged supporting the use of regional anaesthesia over general anaesthesia in patients undergoing simple, relatively short lumbar spine operations . Although this topic has been recently discussed in two narrative reviews , there has not yet been a meta‐analysis specifically comparing the impact of spinal anaesthesia and general anaesthesia on peri‐operative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal anaesthesia and general anaesthesia can be used interchangeably in selected and less extensive lumbar spine operations . Each has advantages and disadvantages and may exert distinctive effects on peri‐operative outcome .…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, general anaesthesia renders the patient motionless throughout the procedure and provides a secure airway, although it may lead to haemodynamic instability and greater intra‐operative blood loss, analgesic requirements and postoperative nausea and vomiting . Although the impact of spinal anaesthesia vs. general anaesthesia on peri‐operative outcomes in lumbar spine surgery has been previously investigated, the results lack consistency . We conducted this meta‐analysis based on relevant randomised, controlled trials to specifically compare spinal anaesthesia with general anaesthesia on various peri‐operative outcomes in lumbar spine surgery.…”

Section: Introductionmentioning

confidence: 99%

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Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials

2016

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Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta-analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% CI) with spinal anaesthesia for intra-operative hypertension was 0.31 (0.15-0.64), I = 0% (p = 0.002); for intra-operative tachycardia 0.51 (0.30-0.84), I = 0% (p = 0.009); for analgesic requirement in the postanaesthesia care unit 0.32 (0.24-0.43), I = 0% (p < 0.0001); and for nausea/vomiting within 24 h postoperatively 0.29 (0.18-0.46), I = 12% (p < 0.00001). The standardised mean difference (95% CI) for hospital stay was -1.15 (-1.98 to -0.31), I = 89% (p = 0.007). There was no evidence of a difference in intra-operative hypotension and bradycardia, blood loss, surgical time, analgesic requirement within 24 h postoperatively, and nausea/vomiting in the postanaesthesia care unit. We conclude that spinal anaesthesia appears to offer advantages over general anaesthesia for lumbar spine surgery.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials

2016

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“…Our study revealed that SA shortens both time to surgery in OR (time elapsed from OR entry until incision), and operating time (skin to skin surgery time). These findings are concordant with those of few previous reports (8,10,21).…”

Section: █ Discussionsupporting

confidence: 94%

Effects of anesthesia protocol on perioperative outcomes and costs in lumbar microdiscectomies

Kılıç

Naderi²

2019

Turkish Neurosurgery

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AIM: To compare the effects of spinal anesthesia (SA) and general anesthesia (GA) in lumbar microdiscectomy in terms of their costeffectiveness, and perioperative outcomes. MATERIAL and METHODS: We randomly allocated 100 consecutive patients who were scheduled to undergo elective lumbar microdiscectomy, into either SA or GA groups. We recorded and evaluated various parameters, including demographic aspects, body mass index (BMI), perioperative hemodynamics, time elapsed from operating room (OR) entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, blood loss, post anesthetic care unit (PACU) time, preoperative and postoperative pain scores, postoperative analgesic requirements, first mobilization time, first oral intake, the length of hospital stay, time to return to work, and perioperative anesthetic costs. The patients, anesthesiologists, and neurosurgeons were handed a questionnaire before discharge to determine their satisfaction with the procedure. RESULTS: Several variables were found to be better in the SA group: the mean arterial pressure and heart rate changes were significantly lower, and the time elapsed from OR entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, PACU time, the length of hospital stay, and time to return to work were shorter; furthermore, the postoperative pain scores, the analgesic requirements, the intraoperative blood loss, and the cost of anesthesia were all lower. Moreover the first mobilization and oral intake occurred earlier; and most significantly, the satisfaction of the patients and surgeons was higher in the SA group. Furthermore, we encountered no complications. CONCLUSION: Based on our results, we conclude that SA is reliable and clinically successful procedure in lumbar microdiscectomy.

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Regional Anesthesia in Patients with Spine Pain

Hung

Wang

2019

Spine Pain Care

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Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis

Cited by 28 publications

References 19 publications

Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials

Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials

Effects of anesthesia protocol on perioperative outcomes and costs in lumbar microdiscectomies

Regional Anesthesia in Patients with Spine Pain

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