Degenerative Lumbar Spine Surgeries Under Regional Anesthesia in a Developing Country: An Initial Case Series

Abstract

IntroductionCurrent evidence from developed countries on lumbar spine surgeries under regional anesthesia reports it to be superior to general anesthesia (GA) in terms of decreased anesthesia time, operative time, intraoperative complications such as bleeding, postoperative complications, length of hospital stay, and overall cost. We report the first case series from Pakistan on lumbar spine surgeries under regional anesthesia. MethodsWe utilized spinal anesthesia (SA) for lumbar spine surgeries of 45 patients in a tertiary-care hospital in Karachi, Pakistan. The surgeries were performed as day-care procedures. The preoperative assessments included MRI findings, visual analogue scale (VAS), pre-operative limb powers, and straight leg raise (SLR). Other assessments included total SA time, total surgical time, time of stay in the post-anesthesia care unit (PACU), complications, and total hospital cost. SPSS v26 was used to calculate means and standard deviations. ResultsWe found the total SA time to be about 45 to 60 minutes in most patients (95.6%). The total surgical time was 30 to 45 minutes for most patients. The average time of stay in the PACU was three to four hours. The VAS scores were significantly improved postoperatively with 46.7% (n=21) of patients with a score of 3, 46.7% (n=21) with a score of 2, and 6.7% (n=3) with a score of 1. 71.1% (n=32) patients had day-care surgery, 22.2% (n=10) stayed in the hospital for one day, and 6.7% (n=3) patients stayed for more than one day. Most patients (88.9%, n=40) had no complications, whereas only 11.1% (n=5) complained of PDPH. The total hospital cost was also lesser than procedures under GA. ConclusionWe conclude that SA is well tolerated and has favorable outcomes in terms of cost-effectiveness, anesthesia time, surgical time, and hospital stay; therefore, SA should be considered for a greater number of lumbar spine surgeries, especially in low-middle income countries.