Safety and efficacy of spinal vs general anaesthesia in bone marrow harvesting

Abstract

Summary:Bone marrow harvesting (BMH) can be performed with either general (GA) or spinal anaesthesia (SPA). Whether SPA is advantageous in BMH and if this technique is safe for procedures performed in the prone position is still controversial. To evaluate the safety and efficacy of both anaesthetic techniques in BMH, 37 allogeneic donors (nine female, 28 male; 34.3 ؎ 9 years; ASA class 1-2) received either spinal (group 1, n = 20) or general anaesthesia (group 2, n = 17) according to their personal wishes. Under standardised harvesting conditions, haematology parameters, cell counts (MNC, CD34 + ), haemodynamic parameters, adverse reactions and patient satisfaction were registered. No differences were seen between groups with respect to demographic data, harvesting time (55 ؎ 17 vs 60 ؎ 16 min) and bone marrow cell counts (MNC: 6.68 ؎ 2.1 vs 5.7 ؎ 1.7 ml/10 6 ). The incidence of hypotension was higher in group 1 (45 vs 10.8%; P = 0.042). Postoperative analgesic requirement and emesis were increased in group 2 (P Ͻ 0.04) in comparison to group 1. In conclusion, the present study failed to show superiority of spinal over general anaesthesia with regard to the quality of the harvested bone marrow. However, the lower incidence of complaints after spinal anaesthesia appears to offer an advantage over GA in healthy allogeneic bone marrow donors.

Comparison of general vs regional anaesthesia for BM harvesting: a retrospective study of anaesthesia-related complications

“…Autologous donors of BM, according to our data, needed more autologous and allogeneic blood transfusions than did allogeneic donors, and more autologous blood when BMH was carried out under GA rather than under RA (73 vs 40%, respectively). This is in accordance with data obtained by Burmeister et al 6 in a prospective study of 37 healthy allogeneic donors, in which no difference in blood requirements between the GA and RA groups was found.…”

“…Similar findings have been reported by others while comparing GA with RA for BMH, as well as for another surgical procedures. 6,7,11,13,14 In an earlier retrospective study of 162 BM donations (63 allogeneic and 99 autologous), Lavi et al 4 found that patients who underwent GA required more RBC units than those undergoing RA. Our results do not confirm this finding.…”

“…These benefits include (1) reduced blood loss intra-operatively because of decreasing peripheral venous pressure; (2) patients' ability to change the position of arms, legs and chest, as needed to avoid nerve injury, brachial plexus palsy or pressure necrosis in either the face or chest wall; (3) reduced incidence of nausea and vomiting postoperatively; (4) better postoperative analgesia; (5) decreased stress response; (6) preservation of immune response; (7) shorter hospitalisation time; as well as (8) cost reduction. 5,6,7,8,[9][10][11][12][13][14] These benefits of RA should counterbalance the risk of respiratory complications (including respiratory depression) in a sedated pronepositioned patient when compared with GA (with a secured airway). 14 Spinal and anorectal surgery are the procedures carried out in the same body position as that for BMH (the prone position).…”

“…[4][5][6]15 Currently, there is no consensus regarding the preferable anaesthesia method for BMH, and the choice between GA and RA is still controversial. Only a comparison of these two anaesthesia methods in a well-defined patient setting is sufficient to prove if there are indeed some advantages of one anaesthesia technique over the other.…”

“…Although both methods of anaesthesia are generally considered safe and are commonly used, there are only a few reports in which their safety and efficacy among stem-cell donors have been compared. [4][5][6] The choice of the type of anaesthesia most often depends on local routines as well as on donor and anaesthetist preferences.…”