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Ma K, Uejima JL, Bebawy JF. Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence. J Neurosurg Anesthesiol 2024; 36:109-118. [PMID: 36941119 DOI: 10.1097/ana.0000000000000911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
Neurosurgical procedures are often associated with significant postoperative pain that is both underrecognized and undertreated. Given the potentially undesirable side effects associated with general anesthesia and with various pharmacological analgesic regimens, regional anesthetic techniques have gained in popularity as alternatives for providing both anesthesia and analgesia for the neurosurgical patient. The aim of this narrative review is to present an overview of the regional techniques that have been incorporated and continue to be incorporated into modern neuroanesthesia practice, presenting in a comprehensive way the evidence, where available, in support of such practice for the neurosurgical patient.
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Affiliation(s)
- Kan Ma
- Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - John F Bebawy
- Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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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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Adamczyk K, Koszela K, Zaczyński A, Niedźwiecki M, Brzozowska-Mańkowska S, Gasik R. Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2098. [PMID: 36767465 PMCID: PMC9915556 DOI: 10.3390/ijerph20032098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
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Affiliation(s)
- Kamil Adamczyk
- Department of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Artur Zaczyński
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Marcin Niedźwiecki
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Sybilla Brzozowska-Mańkowska
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Robert Gasik
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Hagan MJ, Telfeian AE, Sastry R, Ali R, Lewandrowski KU, Konakondla S, Barber S, Lane K, Gokaslan ZL. Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series. J Neurosurg Spine 2022; 37:843-850. [PMID: 35986734 DOI: 10.3171/2022.6.spine22451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts. METHODS Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented. RESULTS At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. CONCLUSIONS A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.
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Affiliation(s)
- Matthew J Hagan
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Albert E Telfeian
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rahul Sastry
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rohaid Ali
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Sanjay Konakondla
- 3Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania; and
| | - Sean Barber
- 4Houston Methodist Department of Neurosurgery, Houston, Texas
| | - Kendall Lane
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Abstract
Current advancements in spine surgery have led to a recent interest in regional anesthesia for spine surgery. Spinal anesthesia, epidural anesthesia, and their combination are commonly used modalities for regional anesthesia in spine surgeries. The successful use of regional anesthesia has led to the emergence of several new concepts such as awake spinal fusion and outpatient spinal surgery. Regarding analgesic techniques, several new modalities have been described recently such as erector spinae and thoracolumbar interfascial plane blocks. These regional analgesic modalities are aimed at decreasing perioperative pain and enhancing early recovery in patients undergoing spine surgery. This narrative review focuses on the techniques, indications and contraindications, benefits, and complications of regional anesthesia in the context of spine surgery.
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Sharma R, Huang Y, Dizdarevic A. Blood Conservation Techniques and Strategies in Orthopedic Anesthesia Practice. Anesthesiol Clin 2022; 40:511-527. [PMID: 36049878 DOI: 10.1016/j.anclin.2022.06.002] [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] [Indexed: 06/15/2023]
Abstract
Orthopedic surgery procedures involving joint arthroplasty, complex spine, long bone and pelvis procedure, and trauma and oncological cases can be associated with a high risk of bleeding and need for blood transfusion, making efforts to optimize patient care and reduce blood loss very important. Patient blood management programs incorporate efforts to optimize preoperative anemia, develop transfusion protocols and restrictive hemoglobin triggers, advance surgical and anesthesia practice, and use antifibrinolytic therapies. Perioperative management of anticoagulant therapies, a multidisciplinary decision-making task, weighs in risks and benefits of thromboembolic risk and surgical bleeding and is patient- and surgery-specific.
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Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA. https://twitter.com/Drsharma_richa
| | - Yolanda Huang
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA.
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Li R. Application of Ultrasound-Guided Cervical Plexus Block in Type I Thyroid Cartilage Laryngoplasty and Vocal Cord Medialization Surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221115114. [PMID: 35861187 DOI: 10.1177/01455613221115114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Under the background that cervical plexus block (CPB) is often adopted for type I thyroid cartilage laryngoplasty (TCL) and vocal cord medialization (VCM), the present study sought to investigate whether ultrasound-guided CPB (USCPB) could improve the efficiency of type I TCL and VCM. METHODS Patients with TCL were enrolled and subjected to deep and superficial USCPBs. Intravenous dexmedetomidine pumping was used to assist the painless sedation and ensure the patients to be awake for phonation during surgery. Blood pressure, electrocardiogram, heart rate (HR), and blood oxygen saturation (SpO2) of patients were recorded. The complications, like local anesthetic toxicity and total spinal anesthesia, were monitored. RESULTS All patients underwent CPB without infiltration anesthesia and complication. The use of Sufentanil at the dose of 5-10 μg was reported in 2 of 15 patients. No Horner syndrome was discovered in patients after anesthesia, and total intravenous anesthesia with intravenous pumping of dexmedetomidine was effective. During surgery, HR, diastolic blood pressure and mean blood pressure were barely changed, but systolic blood pressure was decreased. CONCLUSION Ultrasound-guided CPB with the intravenous dexmedetomidine pumping is a safe anesthesia method for patients during TCL.
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Affiliation(s)
- Ronggang Li
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Bithal PK, Rath GP. Regional Anesthesia Practice in Neurosurgery. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1734402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Parmod K. Bithal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Mulcahy MJ, Elalingam T, Jang K, D'Souza M, Tait M. Bilateral cervical plexus block for anterior cervical spine surgery: study protocol for a randomised placebo-controlled trial. Trials 2021; 22:424. [PMID: 34187541 PMCID: PMC8244165 DOI: 10.1186/s13063-021-05377-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background There has been increasing focus to improve the quality of recovery following anterior cervical spine surgery (ACSS). Postoperative pain and nausea are the most common reasons for prolonged hospital stay and readmission after ACSS. Superficial cervical plexus block (SCPB) provides site-specific analgesia with minimal side effects, thereby improving the quality of recovery. The aim of our study was to investigate the effect bilateral cervical plexus block has on postoperative recovery in patients undergoing ACSS. Methods The study is a pragmatic, multi-centre, blinded, parallel-group, randomised placebo-controlled trial. 136 eligible patients (68 in each group) undergoing ACSS will be included. Patients randomised to the intervention group will have a SCPB administered under ultrasound guidance with a local anaesthetic solution (0.2% ropivacaine, 15mL); patients randomised to the placebo group will be injected in an identical manner with a saline solution. The primary outcome is the 40-item quality of recovery questionnaire score at 24 h after surgery. In addition, comparisons between groups will be made for a 24-h opioid usage and length of hospital stay. Neck pain intensity will be quantified using the numeric rating scale at 1, 3, 6 and at 24 h postoperatively. Incidence of nausea, vomiting, dysphagia or hoarseness in the first 24 h after surgery will also be measured. Discussion By conducting a blinded placebo trial, we aim to control for the bias inherently associated with a tangible medical intervention and show the true treatment effect of SCPB in ACSS. A statistically significant result will indicate an overall improved quality of recovery for patients; alternatively, if no benefit is shown, this trial will provide evidence that this intervention is unnecessary. Trial registration ClinicalTrials.gov ACTRN12619000028101. Prospectively registered on 11 January 2019 with Australia New Zealand Clinical Trials Registry
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Affiliation(s)
- Michael J Mulcahy
- Department of Neurosurgery, Nepean Public Hospital, Sydney, Australia. .,Macquarie Neurosurgery, Suite 201, 2 Technology Place, Sydney, Australia.
| | - Thananchayan Elalingam
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Kevin Jang
- Department of Neurosurgery, Nepean Public Hospital, Sydney, Australia
| | - Mario D'Souza
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Matthew Tait
- Department of Neurosurgery, Nepean Public Hospital, Sydney, Australia.,Macquarie Neurosurgery, Suite 201, 2 Technology Place, Sydney, Australia
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Complications following regional anesthesia versus general anesthesia for the treatment of distal radius fractures. Eur J Trauma Emerg Surg 2021; 48:4569-4576. [PMID: 34050773 PMCID: PMC8164052 DOI: 10.1007/s00068-021-01704-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Abstract
Purpose Open reduction and internal fixation (ORIF) are commonly utilized for the repair of distal radius fractures (DRF). While general anesthesia (GA) is typically administered for ORIF, recent studies have also demonstrated promising results with the usage of regional anesthesia (RA) in the surgical treatment of distal radius fractures. This study will compare complication rates between the use of RA versus GA for ORIF of DRFs. Methods A multi-institutional surgical registry was utilized to identify patients who had undergone ORIF for DRFs from 2005 to 2018—these patients were stratified into GA and RA cohorts. Patients were matched utilizing coarsened-exact-matching (CEM) to compare postoperative outcomes and rates of 30-day complications were compared between the two cohorts. Results Upon CEM-matching, 1191 patients receiving RA were matched to 9250 patients who had received GA, with a multivariate imbalance measure (L1) statistic of < 0.001. In the matched-cohort analysis, no significant differences were observed in rates of any complication (all p ≥ 0.083). On multivariate regression analyses, RA was not associated with increased risk for any complication (p = 0.445), minor complications (p = 0.093), major complications (p = 0.758), unplanned reoperations (p = 0.355), unplanned readmissions (p = 0.799), or mortality (p = 0.579). Conclusion With similar safety profiles, RA is a safe and reasonable alternative to GA when managing DRFs surgically. RA may be the preferred anesthetic technique for ORIF of DRFs in patients at high risk with GA, such as those with reactions to GA in the past or with significant cardiopulmonary risk factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01704-1.
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Fiani B, Reardon T, Selvage J, Dahan A, El-Farra MH, Endres P, Taka T, Suliman Y, Rose A. Awake spine surgery: An eye-opening movement. Surg Neurol Int 2021; 12:222. [PMID: 34084649 PMCID: PMC8168649 DOI: 10.25259/sni_153_2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Awake surgery is performed in multiple surgical specialties, but historically, awake surgery in the field of neurosurgery was limited to craniotomies. Over the past two decades, spinal surgeons have pushed for techniques that only require regional anesthesia as they may provide reduced financial burdens on patients, faster recovery times, and better outcomes. The list of awake spine surgeries that have been found in the literature include: laminectomies/discectomies, anterior cervical discectomy and fusions (ACDFs), lumbar fusions, and dorsal column (DC) stimulator placement. Methods: An extensive review of the published literature was conducted through PubMed database with articles containing the search term “awake spine surgery.” No date restrictions were used. Results: The search yielded 293 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Findings have shown that lumbar laminectomies performed with local anesthesia have shown shorter operating time, less postoperative nausea, lower incidence of urinary retention and spinal headache, and shorter hospital stays when compared to those performed under general anesthesia. Lumbar fusions with local anesthesia showed similar outcomes as patients reported better postoperative function and fewer side effects of general anesthesia. DC stimulator placement performed with local anesthesia is advantageous as it allows real time patient feedback for surgeons as they directly test affected nerves. However, spontaneous movement during the placement of DC stimulators is associated with higher failure rates when compared to general anesthesia (29.7% vs. 14.9%). Studies have shown that the use of local anesthesia during ACDFs has no significant differences when compared to general anesthesia, and patient’s report better tolerated pain with general anesthesia. Conclusion: The use of awake spine surgery is beneficial for those who cannot undergo general anesthesia. However, it is limited to patients who can tolerate prone positioning with no central airway (i.e., normal BMI with a healthy airway), have no pre-existing mental health conditions (e.g., anxiety), and require a minimally invasive procedure with a short operating time. Future studies should focus on long-term efficacies of these procedures that provide further insight on the indications and limitations of awake spine surgery.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Jacob Selvage
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Alden Dahan
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Mohamed H El-Farra
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Philine Endres
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Taha Taka
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Yasmine Suliman
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Alexander Rose
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
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Are outpatient three- and four-level anterior cervical discectomies and fusion safe? Spine J 2021; 21:231-238. [PMID: 33049410 DOI: 10.1016/j.spinee.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The safety of outpatient one- and two-level anterior cervical discectomy and fusion (ACDF) has been validated in a number of recent studies. However, recent advancements in anesthetic and surgical technique have rendered procedures previously only performed in an inpatient setting, such as three- and four-level ACDF, potentially amenable to outpatient management. PURPOSE The present study aimed to investigate the safety of outpatient three- and four-level ACDF. STUDY DESIGN Retrospective cohort study PATIENT SAMPLE: The National Surgical Quality Improvement Program - a large, prospectively-collected registry - was queried to identify patients undergoing three- and four-level ACDF in an inpatient and outpatient setting. OUTCOME MEASURES The rates of total complications, perioperative blood transfusion, and unplanned hospital readmission in three- and four-level ACDF by inpatient or outpatient surgery status. METHODS Baseline patient characteristics and 30-day outcomes were tabulated and compared by inpatient or outpatient status using bivariate analysis. A multivariate analysis was also employed to adjust for differences in baseline patient characteristics when comparing outcomes, and was also used to identify independent predictors of complications and readmissions in patients undergoing three- and four-level ACDF. RESULTS In total 3,441 patients underwent three- or four-level ACDF, with 2,718 (79.0%) procedures occurring inpatient and 723 (21.0%) outpatient. Of patients undergoing outpatient ACDF, 596 patients (82.4%) underwent a three-level and 127 patients (17.6%) underwent four-level procedures. There was an increase in the utilization of outpatient procedures, increasing from 7.0% to 32.9% between 2011 and 2018. Patients undergoing outpatient surgery were younger, white, more likely to have three-level fusions (vs four-level), had a lower American Society of Anesthesiologists (ASA) classification, and were less likely to have a history of diabetes mellitus or dependent functional status. Among the inpatient and outpatient cohorts, there was no significant difference in the rates of total complications (4.49% vs 2.49%) or unplanned readmissions (4.96% vs 3.72%). Increasing age, operative duration, and ASA classification were independent predictors of complications and readmissions, however, inpatient or outpatient surgery status and number of levels fused was not. CONCLUSIONS This present study represents one of the largest cohorts of patients undergoing outpatient three- and four-level ACDF. Outpatient multilevel ACDF is performed in younger and healthier patients, with three-level procedures more commonly the four-level. There was no observed increased rates of total complications or readmissions in patients undergoing outpatient relative to inpatient surgery, however, we did identify increased age, operative duration, and ASA classification as independent predictors of these complications. Patient selection for outpatient procedures is of the highest importance, and future studies developing reproducible selection criteria are warranted.
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Abstract
Regional anesthesia has been an undervalued entity in neuroanesthetic practice. However, in the past few years, owing to the development of more advanced techniques, drugs and the prolific use of ultrasound guidance, the unrecognised potential of these modalities have been highlighted. These techniques confer the advantages of reduced requirements for local anesthetics, improved hemodynamic stability in the intraoperative period, better pain score postoperatively and reduced analgesic requirements in the postoperative period. Reduced analgesic requirement translates into lesser side effects associated with analgesic use. Furthermore, the transition from the traditional blind landmark-based techniques to the ultrasound guidance has increased the reliability and the safety profile. In this review, we highlight the commonly practised blocks in the neuroanesthesiologist's armamentarium and describe their characteristics, along with their individual particularities.
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Affiliation(s)
- Ashutosh Kaushal
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Kai-Hong Chan A, Choy W, Miller CA, Robinson LC, Mummaneni PV. A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note. Neurosurg Focus 2020; 46:E16. [PMID: 30933917 DOI: 10.3171/2019.1.focus18510] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/15/2019] [Indexed: 11/06/2022]
Abstract
Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is associated with improved patient-reported outcomes in well-selected patients. Recently, some neurosurgeons have aimed to further improve outcomes by utilizing multimodal methods to avoid the use of general anesthesia. Here, the authors report on the use of a novel awake technique for MI-TLIF in two patients. They describe the successful use of liposomal bupivacaine in combination with a spinal anesthetic to allow for operative analgesia.
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Zeng Y, Wan J, Ren H, Lu J, Zhong F, Deng S. The influences of anesthesia methods on some complications after orthopedic surgery: a Bayesian network meta-analysis. BMC Anesthesiol 2019; 19:49. [PMID: 30967113 PMCID: PMC6456996 DOI: 10.1186/s12871-019-0701-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Although several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery. Methods According to the searching strategy, anesthesia associated studies in orthopedic surgery were screened from Pubmed, Embase, and the Cochrane Library up to Mar. 10th, 2018. Then, complications and demographic data were extracted and quality of studies was assessed using Cochrane Collaboration recommendations. ADDIS software was used to perform the network meta-analysis. Pooled effect size was calculated using random effective model or consistency model, and presented with odds ratio (OR) and 95% confidence interval (CI). Results According to the selective criteria, a total of 23 studies with 2393 patients were enrolled in this study. Quality assessment revealed all studies had an ordinary quality. Network meta-analyses revealed that nerve block analgesia (NBA) presented a lower effect on the occurrence of post-operative nausea or vomiting (PONV; OR = 0.17, 95% CI: 0.06–0.39) and urine retention (OR = 0.07, 95% CI: 0.01–0.37) compared with epidural anesthesia (EA). Interscalene block (ISB) and local infiltration analgesia (LIA) could significantly reduce the occurrence of back pain compared with EA (OR = 0.00, 95% CI = 0.00–0.30; OR = 0.00, 95% CI = 0.00–0.25). Conclusion NBA presented an effective role in reliving the occurrence of PONV and urine retention, and ISB and LIA relieved the back pain compared with EA after orthopedic surgery.
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Affiliation(s)
- Yuqing Zeng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China.,Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Junming Wan
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Haiyong Ren
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jianwei Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fuhua Zhong
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shu Deng
- Department of Hematology, The First Affliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang Province, People's Republic of China.
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Abstract
PURPOSE OF REVIEW With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. RECENT FINDINGS Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. SUMMARY Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.
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Kaydu A, Kılıç ET, Gökçek E, Akdemir MS. A Safe Regional Technique in a High-risk Patient: Cervical Plexus Blockage. Anesth Essays Res 2017; 11:1118-1120. [PMID: 29284890 PMCID: PMC5735465 DOI: 10.4103/aer.aer_135_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Regional anesthesia in the form of combined cervical plexus block is gaining popularity as a technique of choice for cervical spine surgeries, especially for urgent ones. An important advantage is that it allows continuous monitoring of patient's neurological status. The success of the block often depends on accurate placement of the local anesthetic. Landmarks for the block are therefore of great importance. In this case, we aimed to present a 74-year-old man with C4–5 odontoid fracture. We planned to perform a unilateral combined cervical plexus block for anterior cervical instrumentation and fusion (ACIF) operation because of his associated high-risk comorbid disorders.
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Affiliation(s)
- Ayhan Kaydu
- Department of Anaesthesiology, Diyarbakır Selahaddini Eyyübi State Hospital, Diyarbakır, Turkey
| | - Ebru Tarıkçı Kılıç
- Department of Anaesthesiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Erhan Gökçek
- Department of Anaesthesiology, Diyarbakır Selahaddini Eyyübi State Hospital, Diyarbakır, Turkey
| | - Mehmet Salim Akdemir
- Department of Anaesthesiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
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