Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients

Abstract

BackgroundPrevious studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.Materials and methodsA retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients.ResultsSA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness.ConclusionSA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting.

Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience

“…They observed an increased incidence of hypotension in SA patients, concluding that GA provides greater hemodynamic stability [8]. In the study by Pierce et al, vasopressor use was more frequent with SA [17]. Interestingly, our results show less frequent vasopressor use during SA cases which is consistent with a previous finding [21].…”

“…Previous publications vary in their hemodynamic findings but provide fewer hemodynamic management details. It is unclear from some reports whether apparent greater stability with SA or with GA reflects specific intervention, thereby confounding interpretation [6, 9, 10, 12, 17]. Our findings about the frequency of vasopressor use are consistent with a previous report [21].…”

“…A few reports identify the vasoactive drugs (atropine and/or ephedrine) used to manage hemodynamics during SA for lumbar spine surgery [2, 8–10, 26, 27]. Other publications state that vasoactive agents were used, but they are not identified [6, 7, 12, 17, 21]. A number of studies do not report whether vasoactive drugs were used to manage hemodynamics [4, 5, 11, 13, 14, 16, 18].…”

Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study

“…The authors recognize that chloroprocaine is not compared to another anesthetic in terms of effectiveness. However, its non-inferiority to bupivacaine has been previously described in the study by Lacasse et al Current studies also suggest its non-inferiority to general anesthesia and its legitimacy to replace lidocaine [8,22].…”

General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty

“…For costs of spinal anesthesia and general anesthesia, many studies shown that spinal anesthesia lead to lower health care costs. [22–24] Since there was no direct comparison between the costs of these 2 approaches. Thus, more studies were needed to identify the economic costs of the 2 methods.…”