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Kalluri MH, Edalatpour A, Kohan J, Bevil K, Gander BH. Utility of spinal anesthesia in plastic surgery and other surgical subspecialties: A literature review. J Plast Reconstr Aesthet Surg 2024; 95:266-272. [PMID: 38941780 DOI: 10.1016/j.bjps.2024.05.059] [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: 02/19/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Spinal anesthesia (SA) is commonly used within the specialties of orthopedic surgery, obstetrics and gynecology, spine surgery, and general surgery, and offers several benefits over general anesthesia (GA). However, SA is used much less frequently in plastic surgery. This review analyzed currently existing data on SA use across various surgical specialties and compared the benefits and complications of SA to those of GA, to assess its utility and potential for more widespread use in plastic surgery. METHODS A comprehensive literature review was conducted using the PubMed and Cochrane Library databases to evaluate the utility of SA in plastic surgery. Indications, contraindications, and data on the use of SA across various surgical specialties were reviewed. Benefits, complications, and cost-effectiveness were also assessed. Finally, the utility of SA in plastic surgery was evaluated based on the available literature. RESULTS SA has been shown to yield several benefits and fewer risks than GA, including a higher possibility of early discharge, decreased costs, better pain and postoperative nausea and vomiting control, and decreased risk of deep venous thrombosis and pulmonary embolism. CONCLUSION Although commonly used for procedures across various surgical specialties such as obstetrics and gynecology, urology, and orthopedic surgery, SA is less frequently used within plastic surgery. Plastic surgery procedures that would benefit from the use of SA include those below the umbilicus such as liposuction, lower extremity procedures, and perineal procedures, and owing to its benefits, we recommend that SA be used more often within plastic surgery under appropriate clinical circumstances.
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Affiliation(s)
- M H Kalluri
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A Edalatpour
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J Kohan
- The Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - K Bevil
- Department of Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B H Gander
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Qian D, Olumuyide E, Keswani A, Lin HM, Ouyang Y, DeMaria S, Poeran J, Park CH, Burnett GW. The Impact of Race/Ethnicity on Disparities in Utilization and Outcomes of Neuraxial Anesthesia for Hip and Femoral Shaft Fractures. J Clin Med 2024; 13:3999. [PMID: 39064039 PMCID: PMC11277043 DOI: 10.3390/jcm13143999] [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: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: The use of neuraxial anesthesia versus general anesthesia for hip fracture surgery remains an active area of research, with recent studies demonstrating mixed findings supporting neuraxial over general anesthesia. The benefits of neuraxial anesthesia have been documented in associated surgeries, including total joint arthroplasty. However, racial disparities in the administration of neuraxial anesthesia have been identified in numerous procedures. We aimed to examine the association of race/ethnicity with neuraxial anesthesia use and the effect of neuraxial anesthesia on length of stay, non-home discharge, 30-day severe adverse events, and rates of readmission among patients undergoing isolated hip and femoral shaft fracture operations. Methods: The American College of Surgeons National Quality Improvement Program database was queried for isolated hip or femoral shaft fractures from 2015 to 2019. Stepwise logistic regression was performed to assess the relationship between race/ethnicity and neuraxial anesthesia use. Within each sex-race stratum, neuraxial anesthesia recipients were propensity-matched to general anesthesia recipients in a 1:2 ratio. Logistic regression and negative binomial regression were performed on the propensity-matched cohort. Results: A total of 12,004 neuraxial and 64,250 general anesthesia hip and femoral shaft fracture patients were identified. Compared to White patients, Black and Hispanic patients were between 0.64 and 0.61 times less likely to receive neuraxial anesthesia over general anesthesia, respectively (p < 0.05). 11,993 patients who received neuraxial anesthesia were propensity matched to 23,946 patients who received general anesthesia. Propensity-matched logistic regressions found that neuraxial anesthesia was associated with decreased length of stay, 30-day severe adverse events, and acute rehab/skilled nursing facility discharge for White patients (p < 0.05 for all), but only decreased length of stay in Black and Hispanic patients (p = 0.01 and p = 0.02, respectively). Conclusions: Notable disparities exist in the administration of neuraxial anesthesia for isolated hip and femoral shaft fracture patients. Hispanic and Black race/ethnicity in particular influences provision of neuraxial anesthesia. Further research is required to understand the degree of effect modification and root causes of regional anesthesia access and benefits for this high-volume patient population.
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Affiliation(s)
- Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Ezekiel Olumuyide
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Aakash Keswani
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
| | - Chang H. Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Garrett W. Burnett
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
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Ledesma I, Stieger A, Luedi MM, Romero CS. Spinal anesthesia in ambulatory patients. Curr Opin Anaesthesiol 2024:00001503-990000000-00211. [PMID: 38979677 DOI: 10.1097/aco.0000000000001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PURPOSE OF THIS REVIEW To assess current practice in the use of spinal anesthesia in major ambulatory surgery, highlighting its advantages over general anesthesia and identifying potential areas for improvement to facilitate a transition to a sustainable healthcare system. RECENT FINDINGS Spinal anesthesia might be preferred in selected populations when compared to general anesthesia providing the highest standards of healthcare quality.The use of local anesthetics with short half-life has proven to be efficient in achieving high anesthesia success rates. Spinal anesthesia does not increase perioperative complications; instead, it has shown a reduction in postoperative nausea and vomiting, an improvement in patient comfort, and a favorable economic impact when compared to general anesthesia. SUMMARY Spinal anesthesia is an appropriate method for anesthesia in ambulatory patients, offering advantages over general anesthesia in selected populations.The use of spinal anesthesia is expanding to meet surgical needs. Therefore, it is crucial to plan ahead and anticipate organizational failures in the ambulatory setting to maintain safety and efficiency during outpatient procedures and surgeries.
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Affiliation(s)
- Ignacio Ledesma
- Department of Anaesthesiology and Critical Care, Hospital General Universitario De Valencia, Valencia, Spain
| | - Andrea Stieger
- Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario De Valencia, Valencia, Spain; Research Methods Department, Universidad Europea de Valencia, Valencia, Spain
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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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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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Jadczak CN, Vanjani NN, Pawlowski H, Cha EDK, Lynch CP, Prabhu MC, Hartman TJ, Nie JW, MacGregor KR, Zheng E, Oyetayo OO, Singh K. The Current Status of Awake Endoscopic Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 180:e198-e209. [PMID: 37714457 DOI: 10.1016/j.wneu.2023.09.023] [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: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To examine the use of local anesthesia and/or conscious sedation in endoscopic spine procedures within the past decade. METHODS This systematic review abided by PRISMA guidelines. Embase, PubMed, Google Scholar, and Cochrane databases were searched for post-2011 articles with patients >18 years old, lumbar/cervical percutaneous endoscopic spine procedures using local/awake anesthesia, and patient/surgical outcomes. Reviews, book chapters, single case reports, or small case series (n ≤15 patients) were excluded. Scoring systems of the National Institutes of Health quality assessment tool, Newcastle-Ottawa Scale, and Cochrane Risk of Bias evaluated interventional case series, comparative studies, and randomized control trials, respectively. RESULTS Twenty-six articles were included, with 4 studies comparing general and local anesthesia. Of 2113 total patients, 1873 patients received local anesthesia. Significant improvements were seen in pain and disability scores. Studies that included MacNab scores showed that 96% of patients rated their postoperative satisfaction as excellent to good. Subanalysis of comparative studies showed a reduced risk of surgical/major medical complications and a slight increased risk for minor medical complications among awake spine patients. Length of stay was shorter for patients receiving local anesthesia. CONCLUSIONS The current systematic review and meta-analysis shows that use of local anesthesia is a safe and effective alternative to general anesthesia among different endoscopic spinal procedures. Although awake spine surgery is associated with a decreased risk of severe complications, lower revision rates, and higher postoperative satisfaction, more robust studies involving larger cohorts of patients are needed to evaluate the true impact of awake spine surgery on outcomes.
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Affiliation(s)
- Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Schubert AK, Wiesmann T, Wulf H, Dinges HC. Spinal anesthesia in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:109-121. [PMID: 37321760 DOI: 10.1016/j.bpa.2023.04.002] [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: 12/20/2022] [Revised: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/17/2023]
Abstract
Spinal anesthesia is a safe alternative to general anesthesia but remains underrepresented in the ambulatory setting. Most concerns relate to low flexibility of spinal anesthesia duration and the management of urinary retention in the outpatient setting. This review focuses on the characterization and safety of the local anesthetics that are available to adapt spinal anesthesia very flexibly to the needs of ambulatory surgery. Furthermore, recent studies on the management of postoperative urinary retention provide evidence for safe, but report wider discharge criteria and much lower hospital admission rates. With the local anesthetics that have current approval for usage in spinal anesthesia, most requirements for ambulatory surgeries can be met. The reported evidence on local anesthetics without approval supports clinically established off-label use and can improve the results even further.
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Affiliation(s)
- Ann-Kristin Schubert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany; Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum Schwäbisch-Hall, Schwäbisch-Hall, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany.
| | - Hanns-Christian Dinges
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany
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Muacevic A, Adler JR, Akhtar Khan S, Hussain M, Ahmed U. Degenerative Lumbar Spine Surgeries Under Regional Anesthesia in a Developing Country: An Initial Case Series. Cureus 2023; 15:e34065. [PMID: 36843830 PMCID: PMC9943688 DOI: 10.7759/cureus.34065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Current evidence from developed countries on lumbar spine surgeries under regional anesthesia reports it to be superior to general anesthesia (GA) in terms of decreased anesthesia time, operative time, intraoperative complications such as bleeding, postoperative complications, length of hospital stay, and overall cost. We report the first case series from Pakistan on lumbar spine surgeries under regional anesthesia. Methods We utilized spinal anesthesia (SA) for lumbar spine surgeries of 45 patients in a tertiary-care hospital in Karachi, Pakistan. The surgeries were performed as day-care procedures. The preoperative assessments included MRI findings, visual analogue scale (VAS), pre-operative limb powers, and straight leg raise (SLR). Other assessments included total SA time, total surgical time, time of stay in the post-anesthesia care unit (PACU), complications, and total hospital cost. SPSS v26 was used to calculate means and standard deviations. Results We found the total SA time to be about 45 to 60 minutes in most patients (95.6%). The total surgical time was 30 to 45 minutes for most patients. The average time of stay in the PACU was three to four hours. The VAS scores were significantly improved postoperatively with 46.7% (n=21) of patients with a score of 3, 46.7% (n=21) with a score of 2, and 6.7% (n=3) with a score of 1. 71.1% (n=32) patients had day-care surgery, 22.2% (n=10) stayed in the hospital for one day, and 6.7% (n=3) patients stayed for more than one day. Most patients (88.9%, n=40) had no complications, whereas only 11.1% (n=5) complained of PDPH. The total hospital cost was also lesser than procedures under GA. Conclusion We conclude that SA is well tolerated and has favorable outcomes in terms of cost-effectiveness, anesthesia time, surgical time, and hospital stay; therefore, SA should be considered for a greater number of lumbar spine surgeries, especially in low-middle income countries.
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Azad TD, Alomari S, Khalifeh JM, Ahmed AK, Musharbash FN, Mo K, Lubelski D, Witham TF, Bydon A, Theodore N. Adoption of awake spine surgery - trends from a national registry over 14 years. Spine J 2022; 22:1601-1609. [PMID: 35525378 DOI: 10.1016/j.spinee.2022.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Awake spine surgery is growing in popularity, and may facilitate earlier postoperative recovery, reduced cost, and fewer complications than spine surgery conducted under general anesthesia (GA). However, trends in the adoption of awake (ie, non-GA) spine surgery have not been previously studied. PURPOSE To investigate temporal trends in non-GA spine surgery utilization and outcomes in the United States. STUDY DESIGN/SETTING A retrospective observational study. PATIENT SAMPLE Patients undergoing cervical or lumbar decompression or/and fusion from the American College of Surgeons National Surgical Quality Improvement Program database records dated 2005-2019. OUTCOME MEASURES The primary outcome was the adoption trends of awake cervical and lumbar spine operations from 2005 to 2019. The secondary outcomes included the outcomes trends of 30-day complications, readmission rates, and length of stay in cervical and lumbar spine operations from 2005 to 2019. METHODS Patients were stratified into two groups: GA and non-GA (regional, epidural, spinal, monitored anesthesia care/intravenous sedation). Pearson chi-square or Fisher exact test and independent-sample t test were used to compare demographics between groups. Jonckheere-Terpstra test was used to determine whether trends and outcomes of non-GA operations from 2005 to 2019 were statistically significant. No non-GA spine operations were reported in the database from 2005 to 2006. RESULTS We included 301,521 patients who underwent cervical or lumbar spine operations from 2005 to 2019. GA was used in 294,903 (97.8%) operations; 6,618 (2.2%) operations were non-GA. Patients in the non-GA cohort were more likely to be younger (50.1 vs 57.2 years; p<.001), less likely to have American Society of Anesthesiologists classification ≥3 (39.7% vs 48.3%; p<.001), and to have lower BMI (27.8 vs 31.5 kg/m2; p<.001), outpatient admission status (10.8% vs 4.0%; p<.001), and fewer bleeding disorders (0.0% vs 1.2%; p<.001). The proportion of non-GA spine operations increased from nearly 0% in 2005 to 2.1% in 2019. The increase in non-GA operations was statistically significant in cervical (0.0%-1.1%) and lumbar (0.0%-2.9%) operations. For non-GA lumbar operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (19.1%-5.4%, p<.05; 5.9%-2.8%, p<.05; 30.9 hours-24.9 hours, p<.05, respectively). Similarly, for non-GA cervical operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (20.1%-6.1%, p<.05; 6.7%-3.7%, p<.05; 27.0-20.0 hours p<.05, respectively). CONCLUSIONS Our trends analysis revealed increasing utilization and improved outcomes of non-GA spine surgery from 2005 to 2019; however, the proportion of non-GA spine operations remains small. Future research should investigate the barriers to adoption of non-GA spine surgery.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Jawad M Khalifeh
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Farah N Musharbash
- Department of Orthopedic Surgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Kevin Mo
- Department of Orthopedic Surgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA.
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10
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Mohammad Ismail A, Forssten MP, Bass GA, Trivedi DJ, Ekestubbe L, Ioannidis I, Duffy CC, Peden CJ, Mohseni S. Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study. Trauma Surg Acute Care Open 2022; 7:e000957. [PMID: 36148316 PMCID: PMC9486374 DOI: 10.1136/tsaco-2022-000957] [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: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated the association between mode of anesthesia and postoperative morbidity and mortality with subgroup analyses. Methods This is a retrospective study using all consecutive adult patients who underwent emergency hip fracture surgery in Orebro County, Sweden, between 2013 and 2017. Patients were extracted from the Swedish National Hip Fracture Registry, and their electronic medical records were reviewed. The association between the type of anesthesia and 30-day and 90-day postoperative mortality, as well as in-hospital severe complications (Clavien-Dindo classification ≥3a), was analyzed using Poisson regression models with robust SEs, while the association with 1-year mortality was analyzed using Cox proportional hazards models. All analyses were adjusted for potential confounders. Results A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of 30-day postoperative mortality (adjusted incident rate ratio (IRR) (95% CI): 0.99 (0.72 to 1.36), p=0.952), 90-day postoperative mortality (adjusted IRR (95% CI): 0.88 (0.70 to 1.11), p=0.281), 1-year postoperative mortality (adjusted HR (95% CI): 0.98 (0.83 to 1.15), p=0.773), or in-hospital severe complications (adjusted IRR (95% CI): 1.24 (0.85 to 1.82), p=0.273), when comparing general and spinal anesthesia. Conclusions Mode of anesthesia during emergency hip fracture surgery was not associated with an increased risk of postoperative mortality or in-hospital severe complications in the study population or any of the investigated subgroups. Level of evidence: Therapeutic/Care Management, level III
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Affiliation(s)
- Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Gary Alan Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dhanisha Jayesh Trivedi
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Lovisa Ekestubbe
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Caoimhe C Duffy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carol J Peden
- Department of Clinical Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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11
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Urick D, Sciavolino B, Wang TY, Gupta DK, Sharan A, Abd-El-Barr MM. 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. J Clin Orthop Trauma 2022; 30:101923. [PMID: 35755932 PMCID: PMC9214827 DOI: 10.1016/j.jcot.2022.101923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES Perform a systematic review and meta-analysis to determine the perioperative utility of general versus spinal anesthesia in the lumbar spine surgery population. METHODS PubMed and Embase were queried for manuscripts reporting perioperative outcomes for patients undergoing one to three-level lumbar spine surgery (including decompression, fusion, and decompression with fusion) using either general or spinal anesthesia. Inclusion criteria included studies published from 2005 to 2021, in English, involving primary data from human subjects. Studies were further screened for data on total operative time, blood loss, intraoperative hypotension, pain scores, postoperative nausea and vomiting, time required in post-anesthesia care unit (PACU), PACU pain anesthetic requirement, and length of stay. Risk of bias for each study was assessed using standardized tools (i.e., RoB 2, ROBINS-I, NOS, as appropriate). Potential predictors of outcome were compared using univariate analysis, and variables potentially associated with outcome were subjected to meta-analysis using Cochran-Mantel-Haenszel testing to produce standard mean differences (SMD) or odds ratios (OR) and 95% confidence intervals (CI). RESULTS In total, 12 studies totaling 2796 patients met inclusion criteria. 1414 (50.6%) and 1382 (49.4%) patients underwent lumbar spine surgery with general anesthesia and spinal anesthesia, respectively. Patients undergoing spinal anesthesia were statistically more likely to have coronary artery disease and respiratory dysfunction. Total operative time (SMD: 12.62 min, 95% CI -18.65 to -6.59), estimated blood loss (SMD: 0.57 mL, 95% CI -0.68 to -0.46), postoperative nausea and vomiting (OR = 0.20, 95% CI 0.15 to 0.26), time required in PACU (SMD = -0.20 min, 95% CI -0.32 to -0.08), and length of stay (SMD = -0.14 day, 95% CI -0.18 to -0.10), all statistically significantly favored spinal anesthesia over general anesthesia (p < 0.05). CONCLUSION In one to three-level lumbar spine surgery, current literature supports spinal anesthesia as a viable alternative to general anesthesia. As this was a heterogeneous patient population, prospective randomized trials are needed to corroborate findings.
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Affiliation(s)
- David Urick
- Duke University School of Medicine, Durham, NC, USA,Corresponding author. 8 Searle Center Dr, Durham, NC 27710, USA.
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12
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Microendoscopic lumbar discectomy with general versus local anesthesia: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100129. [PMID: 35712327 PMCID: PMC9194459 DOI: 10.1016/j.xnsj.2022.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Background While general anesthesia (GA) is the most commonly used anesthetic method during lumbar microendoscopic discectomy (MED), local ± epidural anesthesia (LA) has been gaining popularity as an alternate method. Theoretical advantages of LA include reduced morbidity of anesthesia and improved surgeon-patient communication facilitating less nerve root manipulation and yielding improved surgical outcomes. The objective of this systematic review is to examine the impact of anesthesia type on patient reported outcomes (PROs) and complications with MED. Methods A systematic review and meta-analysis of the available literature examining MED performed under GA or LA was performed. The PubMed, EMBASE and SCOPUS databases were searched from inception to August 16, 2021, utilizing strict inclusion and exclusion criteria with all studies reporting greater than 6 months of follow-up and PRO data. PROs including Visual Analog Scale (VAS)-leg/back, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) and/or 36-Item Short Form (SF-36) physical component scores were collected. Complication, recurrent disc herniation, durotomy and reoperation rates as well as surgical factors were collected. All outcomes were compared between pooled studies examining GA or LA. Risk of bias was assessed with the Newcastle-Ottawa Scale. Results A total of 23 studies consisting of 2,868 patients (1,335 GA, 1,533 LA) were included in the meta-analysis. There were no significant differences between GA and LA groups in regard to overall complication rate, durotomy rate, recurrent disc herniation rate, reoperation rate, blood loss, or surgical time (p > 0.05). Both groups demonstrated significant improvements in ODI and JOA (p<0.0004), however leg and back VAS was only improved in GA (p<0.0025) and not in LA (p>0.058), and SF-36 only in LA (p=0.003). Conclusions Patients undergoing MED under both anesthetic techniques demonstrated significant improvements in ODI and JOA, with no significant differences in complication or reoperation rates. However, patients undergoing GA demonstrated significant improvement in VAS leg and back pain at last follow-up while LA did not. LA may be offered to carefully selected patients and prior studies have demonstrated reduced costs and risks with LA. Conclusions are limited by a high level of study bias and heterogeneity. Further investigation is needed to assess the true effects of GA and LA on outcomes after MED.
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13
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Abbatematteo JM, Snyder LA. Commentary: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition. Neurosurgery 2022; 90:e174-e175. [PMID: 35384927 DOI: 10.1227/neu.0000000000001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joseph M Abbatematteo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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14
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De Biase G, Gruenbaum SE, Quiñones-Hinojosa A, Abode-Iyamah KO. Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition. Neurosurgery 2022; 90:186-191. [PMID: 34995217 DOI: 10.1227/neu.0000000000001777] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There has recently been increasing interest in the use of spinal anesthesia (SA) for spine surgery. The literature that compared spine surgery under SA vs general anesthesia (GA) focused on safety, perioperative outcomes, and costs. OBJECTIVE To test if SA is associated with less postoperative fatigue, cognitive dysfunction, and better quality of life in patients undergoing lumbar spine surgery compared with GA. METHODS We conducted a prospective nonrandomized study in patients undergoing elective lumbar spine surgery under SA or GA by a single surgeon. Fatigue was assessed with the fatigue visual analog scale scale (0-10) and Chalder Fatigue Scale, quality of life with Medical Outcomes Study 12-item Short Form (SF-12), and differences in cognition with Mini-Mental State Examination. Patients were baselined before surgery and assessed again 1 mo after surgery. RESULTS Fifty patients completed the study, 25 underwent surgery under SA and 25 under GA. The groups were homogeneous for baseline clinical characteristics, with no differences in preoperative fatigue, quality of life, and cognition. At 1 mo after surgery, SA compared with GA had better fatigue scores: fatigue visual analog scale (2.9 ± 1.5 vs 5.9 ± 2.3 [P < .0001]) and Chalder Fatigue Scale (11.2 ± 3.1 vs 16.9 ± 3.9 [P < .0001]). One month postoperatively, we observed a significant difference in the SF-12 physical component, with SA having 38.8 ± 8.9 vs 29.4 ± 10.3 (P = .002). We did not observe significant postoperative differences in the SF-12 mental component or Mini-Mental State Examination. CONCLUSION Our study demonstrates that SA offers unique patient-centered advantages to GA for elective spine surgery. One month after surgery, patients who received SA had less postoperative fatigue and better quality of life.
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Affiliation(s)
- Gaetano De Biase
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shaun E Gruenbaum
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
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15
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Yu H, Gild P, Pompe RS, Vetterlein MW, Ludwig TA, Soave A, Kölker M, Maurer V, Marks P, Becker A, Punke MA, Fisch M, Rink M, Dahlem R, Meyer CP. Anesthetic Technique (Spinal vs. General Anesthesia) in Holmium Laser Enucleation of the Prostate: Retrospective Analysis of Procedural and Functional Outcomes among 1,159 Patients. Urol Int 2021; 107:336-343. [PMID: 34404060 DOI: 10.1159/000517542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to compare procedural efficacy, early and late functional outcomes in holmium laser enucleation of the prostate (HoLEP) under spinal anesthesia (SA) versus general anesthesia (GA). METHODS We retrospectively reviewed patients undergoing HoLEP at our institution between 2012 and 2017. Standard pre-, peri-, and postoperative characteristics were compared according to anesthetic technique. Multivariable logistic regression analyses (MVAs) were employed to study the impact of SA on procedural efficacy and postoperative complications. RESULTS Our study cohort consisted of 1,159 patients, of whom 374 (32%) underwent HoLEP under SA. While a medical history of any anticoagulation/antiplatelet therapy except low-dose acetylsalicylic acid was significantly more common among patients undergoing GA (16% vs. 10%, p = 0.001), no other significant differences in preoperative characteristics were noted including age, body mass index, American Society of Anesthesiologists Classification (ASA), prostate size, or International Prostate Symptom Score (IPSS), and quality of life scores. Patients under SA exhibited shorter times of enucleation 42 min (interquartile range [IQR]:27-59 vs. 45 min [IQR: 31-68], p = 0.002), and combined time of enucleation/morcellation/coagulation (57 min [IQR: 38-85] vs. 64 min [IQR: 43-93], p = 0.002), as well as fewer complications (Clavien-Dindo ≥3) (12 [3.2%] vs. 55 [7%], p = 0.013). These associations were confirmed in MVA. Patients did not differ significantly with regard to early micturition including post-void residual volume and maximum flow-rate improvement. At a median follow-up of 33 months (IQR: 32-44), patients with SA had a lower IPSS score (median 3 [IQR: 1-6] vs. 4 [IQR: 2-7], p = 0.039). However, no significant differences were observed with respect to any urinary incontinence, urge symptoms, and postoperative pain. CONCLUSION In this large retrospective series, HoLEP under SA was a safe and efficacious procedure with comparable early and long-term functional outcomes.
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Affiliation(s)
- Hang Yu
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Kölker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Medical Center Frankfurt, Frankfurt, Germany
| | - Mark-Andree Punke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Sarkar S, Banerji A, Chattopadhyaya A, Banerjee S. Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases. J Clin Orthop Trauma 2021; 18:205-208. [PMID: 34026488 PMCID: PMC8122088 DOI: 10.1016/j.jcot.2021.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Conventionally spinal surgeries are done under general anaesthesia (GA). Plenty of literature is available on lumbar spine non-instrumented surgeries under spinal anaesthesia (SA) but handful of literature is there on lumbar spinal instrumented fusion surgeries under SA. We retrospectively analysed the data of 131 patients operated under SA and 108 patients under GA. Aim of the study was to evaluate the safety, advantages and disadvantages of doing lumbar spine instrumented fusion surgeries under SA.In time of COVID-19 pandemic, aerosol generating procedure like intubation, can be avoided if lumbar spine instrumented fusion surgeries are performed under SA. METHODS 239 patients aged between 20 and 79 years operated from January 2014 to December 2019 were included in this study. Indications for surgery were lumbar canal stenosis, degenerative or lytic spondylolisthesis. They underwent L4-L5 or L5-S1 fusion surgeries either TLIF or pedicle screw fixation postero lateral fusion (PLF) and decompression. Out of 239 patients,131 were operated under SA and 108 patients under GA. Heart rate, mean arterial pressure (MAP), blood loss, operating room time, post-op pain relief and need of analgesics, cost of surgery and anaesthesia related complications were analysed. RESULTS The study found significantly less blood loss (p<.05), less OR time, better post-op analgesia and lesser incidence of nausea and vomiting in SA (8.4%) than GA (29.6%). We observed average 10% cost reduction in SA. This study did not find any prone position related complication in regional anaesthesia but one transient brachial plexus palsy and one post-op shoulder pain in GA group. CONCLUSION SA is a safe alternative to GA for lumbar spine instrumented fusion surgery with significant less blood loss, OR time, better post-op analgesia, average 10% overall cost reduction and no reported prone-position related complications.
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Affiliation(s)
- Saikat Sarkar
- Dept of Spine Surgery, Columbia Asia Hospital, Saltlake, Kolkata, India
- KIMS Hospital, Burdwan, India
- ESKAG Sanjeevani N.Home, Kolkata, India
| | - Aditi Banerji
- KIMS Hospital, Burdwan, India
- ESKAG Sanjeevani N.Home, Kolkata, India
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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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18
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Krishan A, Bruce A, Khashaba S, Abouelela M, Ehsanullah SA. Safety and Efficacy of Transurethral Resection of Bladder Tumor Comparing Spinal Anesthesia with Spinal Anesthesia with an Obturator Nerve Block: A Systematic Review and Meta-analysis. J Endourol 2020; 35:249-258. [PMID: 33218270 DOI: 10.1089/end.2020.1054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aims: To investigate whether spinal anesthesia with an obturator nerve block (SA+ONB) can be effectively used for transurethral resection of bladder tumor (TURBT) during the coronavirus disease 2019 (COVID-19) pandemic to improve patient outcomes while also avoiding aerosol-generating procedures (AGPs). We aimed to compare outcomes of TURBTs using spinal anesthesia (SA) alone vs SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumor resection, tumor recurrence, and local anesthetic toxicity. Methods: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, and Web of Science), identifying studies comparing the outcomes of TURBT using SA vs spinal with an ONB. The Cochrane risk-of-bias tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modeling was used to calculate pooled outcome data. Results: Four RCTs and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB was associated with a significantly reduced risk of obturator reflex (p < 0.00001), bladder perforation (p = 0.02), incomplete resection (p < 0.0001), and 12-month tumor recurrence (p = 0.005). ONB was not associated with an increased risk of local anesthetic toxicity (0/159). Conclusion: Our meta-analysis suggests that TURBT using SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as a general anesthesia is paramount, the use of an ONB with SA is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of ONB as well as comparing this method with general anesthesia with complete neuromuscular blockade.
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Affiliation(s)
- Anil Krishan
- Department of Urology, Walsall Manor Hospital, Walsall, United Kingdom
| | - Angus Bruce
- Department of Urology, Walsall Manor Hospital, Walsall, United Kingdom
| | - Shehab Khashaba
- Department of Urology, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Mohamed Abouelela
- Department of Anaesthesia and Pain Management, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Syed Ali Ehsanullah
- Department of Urology, University Hospitals Birmingham, Birmingham, United Kingdom
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19
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Spinal anesthesia for ambulatory surgery: current controversies and concerns. Curr Opin Anaesthesiol 2020; 33:746-752. [DOI: 10.1097/aco.0000000000000924] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study. Adv Ther 2020; 37:527-540. [PMID: 31828612 PMCID: PMC6979445 DOI: 10.1007/s12325-019-01171-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 02/01/2023]
Abstract
Introduction Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Factors determining the choice of anesthesia for short-duration procedures have not been previously identified. Methods This observational, prospective, multicenter, cohort study was conducted between July 2015 and July 2016, in 33 private or public hospitals performing ambulatory surgery. The primary objective was to determine the factors influencing the choice of anesthetic technique (spinal or general anesthesia). Secondary outcomes included efficacy of the anesthesia, time to hospital discharge, and patient satisfaction. Results Among 592 patients enrolled, 309 received spinal anesthesia and 283 underwent general anesthesia. In both study arms, the most frequently performed surgical procedures were orthopedic and urologic (43.3% and 30.7%, respectively); 66.1% of patients were free to choose their type of anesthesia, 21.8% chose one of the techniques because they were afraid of the other, 16.8% based their choice on the expected ease of recovery, 19.2% considered their degree of anxiety/stress, and 16.9% chose the technique on the basis of its efficacy. The median times to micturition and to unassisted ambulation were significantly shorter in the general anesthesia arm compared with the spinal anesthesia arm (225.5 [98; 560] min vs. 259.0 [109; 789] min; p = 0.0011 and 215.0 [30; 545] min vs. 240.0 [40; 1420]; p = 0.0115, respectively). The median time to hospital discharge was equivalent in both study arms. In the spinal anesthesia arm, patients who received chloroprocaine and prilocaine recovered faster than patients who received bupivacaine. The time to ambulation and the time to hospital discharge were shorter (p < 0.001). The overall success rate of spinal anesthesia was 91.6%, and no significant difference was observed between chloroprocaine, prilocaine, and bupivacaine. The patients’ global satisfaction with anesthesia and surgery was over 90% in both study arms. Conclusions Patient’s choice, patient fear of the alternative technique, patient stress/anxiety, the expected ease of recovery, and the efficacy of the technique were identified as the main factors influencing patient choice of short-acting local anesthesia or general anesthesia. Spinal anesthesia with short-acting local anesthetics was preferred to general anesthesia in ambulatory surgeries and was associated with a high degree of patient satisfaction. Trial Registration ClinicalTrials.gov identifier NCT02529501. Registered on June 23, 2015. Date of enrollment of the first participant July 21, 2015.
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21
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Comparison of the Economic Outcomes of Neuroaxial and General Anesthesia for Lumbar Spine Operations: A Systematic Review and Meta-Analysis. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.89989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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