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

Spine surgery under neuraxial vs. general anesthesia: the current state of comparative outcomes research

“…Despite no new prospective RCTs, we identified three systematic reviews, which compared outcomes after spine surgery under neuraxial anesthesia or general anesthesia published within the last 18 months [8,9 ▪▪ ,10 ▪▪ ]. In a stated attempt to provide a more comprehensive and contemporary analysis, two of these included and analyzed a mix of nonrandomized prospective designs, RCTs and retrospective studies [8,9 ▪▪ ].…”

“…The second systematic review analyzed 12 studies/2796 patients from a range of study designs conducted between 2005 and 2021, including four prospective RCTs, two nonrandomized prospective studies and six retrospective observational studies [9 ▪▪ ]. Here, the authors reported risk of bias and graded the quality of evidence according to study-specific rating instruments.…”

Perioperative pain management for spine surgeries

“…When compared with GA, SA provided a better hemodynamic and analgesic profile with a lower incidence of intraoperative hypertension and postoperative nausea and vomiting (NV) 13–15 . Better analgesic outcomes were limited to the immediate postoperative period only and can be explained by longer-lasting sensory blockade than motor blockade after SA and the limited number of studies studying pain parameters after the postanesthesia recovery period 14 .…”

“…Other positive findings seen with neuraxial techniques include reduced surgical duration 15 and blood loss, 16 possibly due to improved surgical exposure from factors like reduced distension of epidural veins in a spontaneously ventilated patient and postsympathectomy hypotension. Some studies have demonstrated reduced postanesthesia care unit LOS and hospital LOS 15 .…”

“…Other positive findings seen with neuraxial techniques include reduced surgical duration 15 and blood loss, 16 possibly due to improved surgical exposure from factors like reduced distension of epidural veins in a spontaneously ventilated patient and postsympathectomy hypotension. Some studies have demonstrated reduced postanesthesia care unit LOS and hospital LOS 15 . SA also possesses the potential to reduce anesthesia time and operating room time by bypassing time-consuming steps like induction, positioning with an endotracheal tube, and emergence from GA.…”