Comparative Effectiveness Research on Spinal versus General Anesthesia for Surgery in Older Adults

Abstract

Comparative effectiveness research aims to understand the benefits and harms of different treatments to assist patients and clinicians in making better decisions. Within anesthesia practice, comparing outcomes of spinal versus general anesthesia in older adults represents an important focus of comparative effectiveness research. The authors review methodologic issues involved in studying this topic and summarize available evidence from randomized studies in patients undergoing hip fracture surgery, elective knee and hip arthroplasty, and vascular surgery. Across contexts, randomized trials show that spinal and general anesthesia are likely to be equivalent in terms of safety and acceptability for most patients without contraindications. Choices between spinal and general anesthesia represent “preference-sensitive” care in which decisions should be guided by patients’ preferences and values, informed by best available evidence.

Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

“…The advantages of epidural anesthesia compared to GA have been demonstrated, including better postoperative analgesia, reduced blood loss, better hemodynamic characteristics, reduced stress response, and lower medical costs. 6,25 However, we believe that LA is more convenient and time-saving, and allows for immediate postoperative neurological examination compared to epidural anesthesia. In addition, LA can avoid some specific complications of epidural anesthesia, such as total spinal anesthesia and postoperative urinary retention.…”

“…4 Additionally, the use of GA during these procedures poses a potential risk, especially for elderly patients with comorbidities. [5][6][7] As a result, awake spinal surgery (ASS), a new strategy combining minimally invasive techniques with conscious LA, is increasingly promoted. 8,9 Several studies have demonstrated the benefits of ASS in reducing complications and accelerating postoperative recovery.…”