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Wilson JP, Bonin B, Quinones C, Kumbhare D, Guthikonda B, Hoang S. Spinal Anesthesia for Awake Spine Surgery: A Paradigm Shift for Enhanced Recovery after Surgery. J Clin Med 2024; 13:5326. [PMID: 39274539 PMCID: PMC11396637 DOI: 10.3390/jcm13175326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS.
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Affiliation(s)
- John Preston Wilson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Bryce Bonin
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Christian Quinones
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Deepak Kumbhare
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Stanley Hoang
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
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Boddeti U, Polavarapu H, Patel S, Choudhary A, Langbein J, Nusraty S, Vatsa S, Brahmbhatt P, Mitha R. Current Status of Awake Spine Surgery: A Bibliometric Analysis. World Neurosurg 2024; 187:194-201.e2. [PMID: 38719075 DOI: 10.1016/j.wneu.2024.04.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Spine surgery accounts for a large proportion of neurosurgical procedures, with approximately 313 million spine surgeries conducted annually worldwide. Considering delayed recovery and postoperative complications that are commonly reported, there has been a recent shift toward minimally invasive spine procedures conducted under local anesthesia. Despite proven success, there exists a limited body of literature on the use of awake surgery in spinal procedures. METHODS A bibliometric analysis was conducted to map the current landscape of work in this field. 190 articles were identified from the Web of Science (Clarivate, NY) database. A comprehensive bibliometric analysis was performed on a narrowed list of the most relevant articles using Bibliometrix, an R-based programming tool. RESULTS There has been a rise in academic papers published on the topic of awake spine surgery since 2016, with an increase in publication count by approximately 18% annually and each article cited approximately ten times on average to date. The year 2022 saw an uptick in publications, with 9 throughout the entire year. The most impactful article, with a total of 95 citations, was published by Sairyo et al.1 Thematic analysis revealed that the terms "lumbar spine" and "stenosis" are well-developed topics in the literature, whereas the topics of "complications," "fusion," and "cost-analysis" are less well-developed topics. CONCLUSIONS This study provides a comprehensive overview of the most-cited articles in the field of awake spine surgery. Specifically, it identifies areas that are well represented in the literature and those which are underrepresented and should be areas of continued future research.
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Affiliation(s)
- Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hanish Polavarapu
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shrey Patel
- Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Aditi Choudhary
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jenna Langbein
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sabrina Nusraty
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sonika Vatsa
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Priya Brahmbhatt
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Lalonde DH, Gruber MM, Ahmad AA, Langer MF, Sepehripour S. New Frontiers in Wide-Awake Surgery. Plast Reconstr Surg 2024; 153:1212e-1223e. [PMID: 38810165 DOI: 10.1097/prs.0000000000011414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. SUMMARY Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.
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Affiliation(s)
| | | | | | - Martin F Langer
- the Clinic for Trauma, Hand, and Reconstructive Surgery, University Clinic Muenster
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Oliver C, Charlesworth M, Pratt O, Sutton R, Metodiev Y. Anaesthetic subspecialties and sustainable healthcare: a narrative review. Anaesthesia 2024; 79:301-308. [PMID: 38207014 DOI: 10.1111/anae.16169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/13/2024]
Abstract
The principles of environmentally sustainable healthcare as applied to anaesthesia and peri-operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri-operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence-based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.
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Affiliation(s)
- C Oliver
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - O Pratt
- Department of Anaesthesia, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - R Sutton
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Y Metodiev
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
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Sikachi R, Oliver LA, Oliver JA, Pai B H P. Perioperative pain management for spine surgeries. Int Anesthesiol Clin 2024; 62:28-34. [PMID: 38063035 DOI: 10.1097/aia.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Rutuja Sikachi
- Mount Sinai West-Morningside Hospitals, New York, New York
| | | | | | - Poonam Pai B H
- Mount Sinai West-Morningside Hospitals, New York, New York
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Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesth Pain Med (Seoul) 2023; 18:349-356. [PMID: 37919919 PMCID: PMC10635856 DOI: 10.17085/apm.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 11/04/2023] Open
Abstract
Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.
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Affiliation(s)
| | - Benayas Begashaw
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
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Kang TH, Kim WJ, Lee JH. Efficacy of the erector spinae plane block with sedation for unilateral biportal endoscopic spine surgery and comparison with other anesthetic methods. Acta Neurochir (Wien) 2023; 165:2651-2663. [PMID: 37278922 DOI: 10.1007/s00701-023-05643-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Erector spinae plane block (ESPB) is a new regional anesthesia. Unilateral biportal endoscopic (UBE) spine surgery, a minimal invasive technique, has been performed under not only general anesthesia (GA) but regional anesthesia including spinal anesthesia (SA). The aims of this study were to evaluate the efficacy of ESPB with sedation for UBE lumbar decompression and compare it with GA and SA. METHOD A retrospective age matched case-control study design was performed. Three groups (20 patients in each group) of patients who underwent UBE lumbar decompressions under each anesthetic method (GA, SA, or ESPB) were formed. The total anesthesia time excluding operation time, postoperative analgesia effects, hospital days, and complications related to anesthetic methods were evaluated. RESULTS In the ESPB group, all the operations were performed without change of anesthetic methods and without anesthetic complications. But there were no anesthetic effects in the epidural space, which resulted in additional intravenous fentanyl usage. The mean of time from initiation of anesthesia to completion of surgical preparation was 23.3 ± 4.7 min in the ESPB group, which was shorter than 32.3 ± 10.8 min in the GA (p value = 0.001) or 33.3 ± 6.7 min in the SA group (p < 0.001). The proportion of patients requiring first rescue analgesia within 30 min was 30% in the ESPB group, which was lower than 85% in the GA (p < 0.001), but no significant different with 10% in the SA (p = 0.11). The mean of total hospital days in the ESPB was 3.0 ± 0.8, shorter than 3.7 ± 1.8 in the GA (p = 0.02) or 3.8 ± 1.1 in the SA group (p = 0.01). There was no case of postoperative nausea and vomiting in the ESBB even without prophylactic antiemesis. CONCLUSION ESPB with sedation is a viable anesthetic option for UBE lumbar decompression.
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Affiliation(s)
- Tae Hoon Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea
| | - Won Joong Kim
- Department of Orthopedic Surgery, Synergy Orthopedic Clinic, Seoul, Republic of Korea.
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University, College of Medicine, Seoul, South Korea.
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