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Boykov N, Ferdinandov D, Vasileva P, Yankov D, Burev S, Tanova R. Thoracic spinal anesthesia with intrathecal sedation for lower back surgery: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1387935. [PMID: 38665296 PMCID: PMC11043566 DOI: 10.3389/fmed.2024.1387935] [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: 02/18/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Background Spinal anesthesia (SA) is a good alternative to general anesthesia (GA) for spine surgery. Despite that, a few case series concern the use of thoracic spinal anesthesia for short-duration surgical interventions. In search of an alternative approach to GA and a better opioid-free modality, we aimed to investigate the safety, feasibility, and patient satisfaction of thoracic SA for spine surgery. Materials and methods We analyzed retrospectively a cohort of 24 patients operated on for a degenerative and osteoporotic pathology of the lower thoracic and lumbar spine. Data was collected from medical records, including clinical notes, operative and anesthesia records, and patient questionnaires. Results Twenty-one surgeries for herniated discs, two for degenerative spinal stenosis, and one for multi-level osteoporotic vertebral body fractures were performed under spinal anesthesia with intrathecal sedation. In all cases, we applied 0.5% isobaric bupivacaine and the following adjuvants: midazolam, clonidine or dexmedetomidine, and dexamethasone. We boosted the anesthesia with local ropivacaine due to inefficient sensory block in two patients. Nobody in the cohort received intravenous opioids, non-steroidal anti-inflammatory drugs, or additional sedation intraoperatively. Postoperative painkillers were upon the patient's request. No significant complications were detected. Conclusion Thoracic spinal anesthesia incorporating adjuvants such as midazolam, clonidine or dexmedetomidine, and dexamethasone demonstrates not only efficient conditions for spine surgery, a favorable safety profile, high patient satisfaction, and intrathecal sedation but also effective opioid-free pain management.
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Affiliation(s)
- Nikolay Boykov
- Department of Anesthesiology and Intensive Care, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dilyan Ferdinandov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Petra Vasileva
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dimo Yankov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Burev
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Rositsa Tanova
- Department of Anesthesiology and Intensive Care, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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Rajjoub R, Ghaith AK, El-Hajj VG, Rios-Zermano J, De Biase G, Atallah E, Tfaily A, Saad H, Akinduro OO, Elmi-Terander A, Abode-Iyamah K. Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:985-1000. [PMID: 38110776 DOI: 10.1007/s00586-023-08071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic. METHODS A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models. RESULTS In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): - 0.40 days; 95% CI - 0.64 to - 0.17) and operative time (MD: - 19.17 min; 95% CI - 29.68 to - 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI 0.37-0.99]). CONCLUSIONS Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Victor Gabriel El-Hajj
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ali Tfaily
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Kingsley Abode-Iyamah
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Ranc PA, Rudel A, Bentellis I, Prestat A, Elbaze S, Sala V, Torre F, Pavan LJ, Uri IF, Amoretti N. Patient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study. J Vasc Interv Radiol 2024; 35:390-397. [PMID: 38110149 DOI: 10.1016/j.jvir.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of percutaneous lumbar discectomy (PLD) under computed tomography (CT) guidance on pain and functional capacities and to estimate the speed of recovery by assessing the time to return to work. MATERIALS AND METHODS Patients treated with PLD were prospectively included between December 2019 and April 2021. Data regarding pain, duration of symptoms, analgesia intakes, time of absence from work, and the Oswestry disability index (ODI) were collected. Patients were followed-up during 6 months. Duration of hospitalization and time to return to work were reported. The Fisher test was used to compare nominal variables, the Kruskal-Wallis test to compare ordinal variables, and the Student t test to compare quantitative continuous variables. RESULTS A total of 87 patients were evaluated (median age, 56 years; interquartile range [IQR], 43-66 years). The median ODI decreased from 44 (IQR, 33-53) to 7 (IQR, 2-17) at 6 months (P < .001). The median visual analog scale score decreased from 8 (IQR, 8-9) to 2 (IQR, 0-3) within 6 months (P < .001). In total, 96.5% of patients were discharged on the day of the procedure, and 3.5% were discharged on the following day. No severe adverse events were reported according to the Society of Interventional Radiology (SIR) classification system. Of the 57 patients previously employed, 50 were able to return to work during the follow-up, with a median time of 8 days (IQR, 0-20 days). CONCLUSIONS Symptomatic lumbar disc herniation can be successfully treated using PLD, resulting in significant improvement in symptoms and functional capacities and a fast return to work.
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Affiliation(s)
- Paul-Alexis Ranc
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France.
| | - Alexandre Rudel
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Imad Bentellis
- Urological Surgery Department, Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Alexandre Prestat
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Simon Elbaze
- Radiology Department, Hôpital Raymond Poincaré, Garches, France
| | - Vincent Sala
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Federico Torre
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Luca-Jacopo Pavan
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Ishaq Fahmi Uri
- Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nicolas Amoretti
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
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Chen R, Chen Y, Yang M, Liu Y, Zhang X, Li J, Yang X, Liao Y, Du G, Cao X. Patients' caring experience during procedures under regional anesthesia in Mainland China: A phenomenology study. Heliyon 2023; 9:e20330. [PMID: 37810870 PMCID: PMC10556589 DOI: 10.1016/j.heliyon.2023.e20330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Although regional anesthesia is common, the procedure results in feelings of uncertainty and anxiety in some patients. Increased care is needed for these patients under general anesthesia. Few studies have focused on the intraoperative caring experience of patients during regional anesthesia. This study focused on the caring experience of patients during procedures involving regional anesthesia. Methods The descriptive phenomenology method of Husserl was employed. Semi-structured interviews were conducted with a purposive sample in five Grade III-A hospitals in Zhengzhou City, Henan Province. The seven-step analysis method of Colaizzi was applied for the analysis, summation, and theme refinement of the interview data. Results A total of 14 patients from five hospitals participated in the interviews. Four domains and 16 themes emerged during analysis: be informed (about the operation site, progression of the operation, informed in advance, receive explanation for abnormal experience); take care of my body (painless, gentle movements, special care); be protected (work seriously, favorable atmosphere, skilled, authority); and treated as an individual (pay attention, accompany, ask for opinions, encourage patient expression, humorous). Conclusion Patients during procedure under regional anesthesia had specific caring experiences relative to other patients. Medical staff should recognize the importance of regional anesthesia patients' intraoperative caring experience. Hospital administrators should offer support to allow healthcare staff to provide targeted caring for patients during procedure under regional anesthesia.
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Affiliation(s)
- Rui Chen
- Department of Infection Control, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, Fuzhou, China
| | - Ying Chen
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Meng Yang
- Department of Infection Control, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Yilan Liu
- Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinhui Zhang
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Jianlei Li
- Department of Knee Injuries, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Xue Yang
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Yufeng Liao
- School of Medical Technology and Nursing, Shenzhen Polytechnic, Shenzhen, Guangdong, China
| | - Guijuan Du
- Department of Nursing, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
| | - Xiangyang Cao
- Department of Hospital President, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, Henan, China
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Kanter M, Hernandez NS, Olmos M, Karimi H, Riesenburger RI, Kryzanski JT. Intraoperative Triggered Electromyography for Pedicle Screw Placement Under Spinal Anesthesia: A Preliminary Report. Oper Neurosurg (Hagerstown) 2023; 24:651-655. [PMID: 36745975 DOI: 10.1227/ons.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/01/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Triggered electromyography (tEMG) is an intraoperative neuromonitoring technique used to assess pedicle screw placement during instrumented fusion procedures. Although spinal anesthesia is a safe alternative to general anesthesia in patients undergoing lumbar fusion, its use may potentially block conduction of triggered action potentials or may require higher threshold currents to elicit myotomal responses when using tEMG. Given the broad utilization of tEMG for confirmation of pedicle screw placement, adoption of spinal anesthesia may be hindered by limited studies of its use alongside tEMG. OBJECTIVE To investigate whether spinal anesthesia affects the efficacy of tEMG, we compare the baseline spinal nerve thresholds during lumbar fusion procedures under general vs spinal anesthesia. METHODS Twenty-three consecutive patients (12 general and 11 spinal) undergoing single-level transforaminal lumbar interbody fusion were included in the study. Baseline nerve threshold was determined through direct stimulation of the spinal nerve using tEMG. RESULTS Baseline spinal nerve threshold did not differ between the general and spinal anesthesia cohorts (3.25 ± 1.14 vs 3.64 ± 2.16 mA, respectively; P = .949). General and spinal anesthesia cohorts did not differ by age, body mass index, American Society of Anesthesiologists score status, or surgical indication. CONCLUSION We report that tEMG for pedicle screw placement can be safely and effectively used in procedures under spinal anesthesia. The baseline nerve threshold required to illicit a myotomal response did not differ between patients under general or spinal anesthesia. This preliminary finding suggests that spinal anesthetic blockade does not contraindicate the use of tEMG for neuromonitoring during pedicle screw placement.
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Affiliation(s)
- Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas S Hernandez
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - James T Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
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Neurosurgical Anesthesia: Optimizing Outcomes with Agent Selection. Biomedicines 2023; 11:biomedicines11020372. [PMID: 36830909 PMCID: PMC9953550 DOI: 10.3390/biomedicines11020372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
Anesthesia in neurosurgery embodies a vital element in the development of neurosurgical intervention. This undisputed interest has offered surgeons and anesthesiologists an array of anesthetic selections to utilize, though with this allowance comes the equally essential requirement of implementing a maximally appropriate agent. To date, there remains a lack of consensus and official guidance on optimizing anesthetic choice based on operating priorities including hemodynamic parameters (e.g., CPP, ICP, MAP) in addition to the route of procedure and pathology. In this review, the authors detail the development of neuroanesthesia, summarize the advantages and drawbacks of various anesthetic classes and agents, while lastly cohesively organizing the current literature of randomized trials on neuroanesthesia across various procedures.
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Wehab Z, Tabarestani TQ, Abd-El-Barr MM, Husain AM. Intraoperative Electromyography in Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Study on Nerve Activation Under the Effects of Local Anesthesia. J Clin Neurophysiol 2022; 39:e26-e29. [PMID: 36007059 DOI: 10.1097/wnp.0000000000000962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY With the versatility of lumbar spine surgery continually expanding, intraoperative electromyography (EMG) has become a common adjunct used to reduce risk of nerve injury and postoperative neurologic deficit. EMG monitoring has been deemed particularly useful in the minimally invasive transforaminal lumbar interbody fusion. A more recent evolution of the minimally invasive transforaminal lumbar interbody fusion entails complete percutaneous access to the disc through Kambin's triangle, followed by a percutaneous lumbar interbody fusion. Given the lack of direct visualization of nervous structures with percutaneous entrance into the disc, there is risk of injury to surrounding nervous structures with this approach. In effort to reduce risk of nerve injury, application of triggered EMG to gauge proximity of nervous tissue has been evaluated. Recently, patients presenting with contraindications or concerns for general anesthesia have been offered the alternative to undergo their procedure with spinal anesthesia, allowing them to remain awake. Spinal anesthesia entails intrathecal administration of local anesthetic, which mechanistically acts to reduce overall excitability of surrounding neural structures. However, nerve activation under conditions of local anesthetic is relatively unknown, and the ability of triggered EMG monitoring to reliably detect nerve proximity becomes questionable. This case report demonstrates nerve activation at thresholds comparable with those seen under general anesthesia. Although this has sparked interest in the possibility that local anesthetic may not remarkably affect nerve excitability as measured by triggered EMG activation, further investigation is recommended to reliably apply triggered EMG monitoring in awake spine surgery.
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Affiliation(s)
- Zaman Wehab
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, U.S.A
| | | | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A ; and
| | - Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, U.S.A
- Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, North Carolina, U.S.A
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Perez-Roman RJ, Govindarajan V, Bryant JP, Wang MY. Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg Focus 2021; 51:E7. [PMID: 34852320 DOI: 10.3171/2021.9.focus21464] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Awake surgery has previously been found to improve patient outcomes postoperatively in a variety of procedures. Recently, multiple groups have investigated the utility of this modality for use in spine surgery. However, few current meta-analyses exist comparing patient outcomes in awake spinal anesthesia with those in general anesthesia. Therefore, the authors sought to present an updated systematic review and meta-analysis investigating the utility of spinal anesthesia relative to general anesthesia in lumbar procedures. METHODS Following a comprehensive literature search of the PubMed and Cochrane databases, 14 clinical studies were included in our final qualitative and quantitative analyses. Of these studies, 5 investigated spinal anesthesia in lumbar discectomy, 4 discussed lumbar laminectomy, and 2 examined interbody fusion procedures. One study investigated combined lumbar decompression and fusion or decompression alone. Two studies investigated patients who underwent discectomy and laminectomy, and 1 study investigated a series of patients who underwent transforaminal lumbar interbody fusion, posterolateral fusion, or decompression. Odds ratios, mean differences (MDs), and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of the total anesthesia time showed that time was significantly less in patients who received spinal anesthesia for both lumbar discectomies (MD -26.53, 95% CI -38.16 to -14.89; p = 0.00001) and lumbar laminectomies (MD -11.21, 95% CI -19.66 to -2.75; p = 0.009). Additionally, the operative time was significantly shorter in patients who underwent spinal anesthesia (MD -14.94, 95% CI -20.43 to -9.45; p < 0.00001). Similarly, when analyzing overall postoperative complication rates, patients who received spinal anesthesia were significantly less likely to experience postoperative complications (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). Furthermore, patients who received spinal anesthesia had significantly lower postoperative pain scores (MD -2.80, 95% CI -4.55 to -1.06; p = 0.002). An identical trend was seen when patients were stratified by lumbar procedures. Patients who received spinal anesthesia were significantly less likely to require postoperative analgesia (OR 0.06, 95% CI 0.02-0.25; p < 0.0001) and had a significantly shorter hospital length of stay (MD -0.16, 95% CI -0.29 to -0.03; p = 0.02) and intraoperative blood loss (MD -52.36, 95% CI -81.55 to -23.17; p = 0.0004). Finally, the analysis showed that spinal anesthesia cost significantly less than general anesthesia (MD -226.14, 95% CI -324.73 to -127.55; p < 0.00001). CONCLUSIONS This review has demonstrated the varying benefits of spinal anesthesia in awake spine surgery relative to general anesthesia in patients who underwent various lumbar procedures. The analysis has shown that spinal anesthesia may offer some benefits when compared with general anesthesia, including reduction in the duration of anesthesia, operative time, total cost, and postoperative complications. Large prospective trials will elucidate the true role of this modality in spine surgery.
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Balain B. Increasing relevance of minimally invasive spinal surgery. J Clin Orthop Trauma 2021; 22:101606. [PMID: 34631413 PMCID: PMC8479478 DOI: 10.1016/j.jcot.2021.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Birender Balain
- Consultant Spine Surgeon, Centre for Spinal Disorders, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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