A Novel Combined Anesthetic Technique to Improve the Surgical Working Conditions of Lumbar and Thoracolumbar Spine Surgery from a Spine Surgeon’s Perspective: A Prospective Randomized Controlled Study

Abstract

Prospective randomized controlled study. Purpose: This study aimed to assess the effects of a different combination of anesthetic techniques in lumbar and thoracolumbar spinal surgeries in terms of muscle relaxation and surgical field in addition to hemodynamic parameters. Overview of Literature: Adequate relaxation of the erector spinae muscle and good surgical fields are preferred in lumbar spine surgeries. The effects of anesthetic techniques on these parameters have not been evaluated from a surgeon's perspective to date. We propose a novel combined anesthetic technique that improves the working conditions from a surgeon's perspective as we hypothesize that combining general anesthesia (GA) with regional anesthesia (RA) might provide benefits for both techniques. Methods: A prospective randomized study of 76 patients who underwent lumbar and thoracolumbar surgeries was conducted by randomly allocating patients into three anesthetic groups: GA alone, GA with spinal anesthesia (SA), and GA with erector spinae plane block (ESPB) by the allocation concealment method to avoid selection bias. The working conditions were assessed by the same operating surgeon who was blinded by the type of anesthesia to eliminate the assessment bias. Muscle relaxation and surgical field were compared among the three groups along with other hemodynamic parameters to identify any significant differences. Results: Significantly better muscle relaxation, surgeon satisfaction, postoperative analgesia, and blood pressure (BP) were observed in the GA+RA when compared to GA alone (p<0.01), whereas no difference was observed between the GA+SA and GA+ESPB groups (p>0.05). Complications were only observed in the GA+SA group (19%). Conclusions:The study results suggest that the addition of RA to GA may provide better working conditions and surgeon's satisfaction by improving relaxation of the erector spinae in addition to decreasing the BP and postoperative pain in contrast to the use of GA alone. The combined GA and ESPB techniques may be a viable anesthetic alternative to provide better working conditions for surgeons.

The efficacy of lumbar erector spinae plane block for postoperative analgesia management in patients undergoing lumbar unilateral bi-portal endoscopic surgery: a prospective randomized controlled trial

“…Subbiah et al [ 9 ] and Goel et al [ 36 ], revealed that ESPB was able to reduce the amount of intraoperative muscarinic medication in open thoracolumbar spine surgery, interpreted as relieving tension in the ESM. The current study similarly found a significant reduction in the number of intraoperative myosin additions and the amount of additions in the ESPB group; however, there was no difference in the total amount of intraoperative myosin between the two groups.…”

“…Previously, analgesia for lumbar spine surgery was limited to lumbar anesthesia, epidural anesthesia, and local infiltration anesthesia; however, their respective drawbacks limited their application. Although lumbar anesthesia and epidural can provide excellent analgesia, they can produce sympathetic or motor block, thereby affecting the judgement of postoperative neurological function [ 9 ]. Local infiltration anesthesia, the utilization of large amounts of drugs, and limited range, for superficial tissue pain control can be, for deep operation pain control is not effective [ 10 ].…”