Efficacy, safety, and reliability of surgery on the lumbar spine under general versus spinal anesthesia- an analysis of 64 cases

Abstract

Quasi-experimental design purpose: Compare intra and postoperative parameters, surgeons' satisfaction, and cost-effectiveness between general anesthesia (GA) and spinal anesthesia (SA) on patients undergoing surgery in the lumbar spine surgery. Overview of literature: Surgery on the lumbar spine is the commonest surgical procedure among all spinal surgical practices. Both the GA and SA are shown to be suitable techniques for performing the surgery safely. GA is used most frequently. But, SA became increasingly more popular because it allows the patient to self-position thereby reducing various complications associated with GA in a prone position. Methods: A total of 64 patients from June 2016 to July 2019 who underwent either discectomy, laminectomy, or lamino-foraminotomy for herniated lumbar disc or canal stenosis in 1 or 2 levels were included. During the study period, 32 patients were non-randomly selected for each of the GA and SA groups. The heart rate (HR), mean arterial pressure (MAP), blood loss, total anesthetic time, surgeons' satisfaction, analgesic requirements, cost of the procedure, and hospital stay were recorded and compared. Results: In the context of demographic characteristics, baseline HR, or MAP, no significant differences were noted between SA and GA groups. Mean anesthetic time, mean PACU time, mean doses of analgesic requirement, cost of anesthesia, and the surgeon's satisfaction was significantly lower in the SA Group (P < 0.05). The blood loss, duration of operation, and hospital stay were not significant too. No major Intra and postoperative complications were reported nor were significant differences found in either series. Conclusion: Safety and efficacy of SA in comparison to GA were similar for the patients undergoing surgery on the lumbar spine. Notable advantages of SA include shorter anesthesia duration, fewer drug requirements, relative cost-effectiveness, and fewer complications rate. Successful surgery can be performed using either anesthesia type.

Perioperative outcomes of general versus spinal anesthesia in the lumbar spine surgery population: A systematic review and meta-analysis of data from 2005 through 2021

“…This also reduces the time required during anesthetic emergence following surgery, which can prolong total operating room time depending on the agents that are utilized. 12,22,24 Spinal anesthesia can also be done outside of the operating room, which can improve throughput and clinical efficiency, as anesthesia can be "induced" while staff members set up operating room equipment. Decreased total operative time is a valuable benefit.…”

Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

“…22 All included studies evaluated a combination of postoperative complication rates, total anesthesia time, operative time, blood loss, LOS, postoperative analgesic use, and anesthesia cost. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] In addition to assessing the impact of spinal anesthesia versus general anesthesia across all surgical techniques, we performed subgroup analyses separated by procedure. Our stratified analyses showed that total anesthesia times were significantly shorter in patients who received spinal anesthesia than in those who received general anesthesia.…”

“…Overall, 14 articles met the inclusion and exclusion criteria from an initial pool of 552 articles. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] All articles evaluated the total intraoperative time, anesthesia duration, postoperative complications, postoperative pain, or a combination thereof. All 14 articles were included in the quantitative analysis and compared the aforementioned outcomes in patients who received general anesthesia with those who received spinal anesthesia and underwent an awake procedure.…”

Commentary: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition

“…Previous studies have demonstrated the feasibility of SA in this patient population and the benefits of SA over GA with respect to hemodynamic stability, postoperative nausea, vomiting, pain control, and cost-effectiveness. 2-5…”

“…Previous studies have demonstrated the feasibility of SA in this patient population and the benefits of SA over GA with respect to hemodynamic stability, postoperative nausea, vomiting, pain control, and cost-effectiveness. [2][3][4][5] The authors hypothesized that SA would be associated with decreased postoperative fatigue and cognitive dysfunction, translating to improved quality of life. The authors report decreased fatigue in the SA group at 1 month after the operation based on a fatigue visual analog scale (VAS) (scored 1-10, no fatigue to extreme fatigue) and the Chandler Fatigue Score (CFQ).…”