General Anesthesia Compared to Spinal Anesthesia for Patients Undergoing Lumbar Vertebral Surgery: A Meta-Analysis of Randomized Controlled Trials

Abstract

Vertebral lumbar surgery can be performed under both general anesthesia (GA) and spinal anesthesia. A clear benefit from spinal anesthesia (SA) remains unproven. The aim of our meta-analysis was to compare the early analgesic efficacy and recovery after SA and GA in adult patients undergoing vertebral lumbar surgery. A systematic investigation with the following criteria was performed: adult patients undergoing vertebral lumbar surgery (P); single-shot SA (I); GA care with or without wound infiltration (C); analgesic efficacy measured as postoperative pain, intraoperative hypotension, bradycardia, length of surgery, blood loss, postoperative side effects (such as postoperative nausea/vomiting and urinary retention), overall patient and surgeon satisfaction, and length of hospital stay (O); and randomized controlled trials (S). The search was performed in Pubmed, the Cochrane Central Register of Controlled Trials, and Google Scholar up to 1 November 2020. Eleven studies were found upon this search. SA in vertebral lumbar surgery decreases postoperative pain and the analgesic requirement in the post anesthesia care unit. It is associated with a reduced incidence of postoperative nausea and vomiting and a higher patient satisfaction. It has no effect on urinary retention, intraoperative bradycardia, or hypotension. SA should be considered as a viable and efficient anesthetic technique in vertebral lumbar surgery.

Awake Lumbar Fusion

“…Although there are purported benefits of awake lumbar fusion, there is no consensus 3 . Potential benefits include shorter surgical time, lower postoperative pain and opioid consumption, shorter hospitalization, patient preference, and reduced postoperative delirium [1][2][3][4][5][6][7][8][9][10][11][12][13] .…”

“…Although there are purported benefits of awake lumbar fusion, there is no consensus 3 . Potential benefits include shorter surgical time, lower postoperative pain and opioid consumption, shorter hospitalization, patient preference, and reduced postoperative delirium [1][2][3][4][5][6][7][8][9][10][11][12][13] . There is growing research to support these claims for awake lumbar laminectomy/diskectomy; however, only a handful of studies directly evaluate awake lumbar fusion.…”

“…Potential risks of awake spine surgery include intraoperative hypotension, injury from the spinal procedure, intraoperative movement, and spinal anesthetic masking intraoperative complications 4,5 . Potential benefits include increased patient satisfaction, less blood loss, stable hemodynamics, less postoperative pain, less postoperative nausea and vomiting, and a lower risk of postoperative delirium 3,[5][6][7] . Although most awake spine surgery literature is on laminectomy/diskectomy, the scant lumbar fusion literature trends toward the same results 8,9 .…”

Study of duration and efficacy of chloroprocaine for spinal anesthesia in infraumbilical surgeries

“…1 Although surgeries of lower abdomen (infraumbilical surgeries) and lower limbs can be safely done under spinal anesthesia, some of the problems associated with performing these surgeries under spinal anesthesia are time to administer spinal anesthesia, postspinal headache, delayed ambulation, and risk of urinary retention. 2 Moreover, spinal anesthesia is an important alternative in many patients with comorbidities in whom general anesthesia may be contraindicated. 2 If proper anesthetic agent is used, spinal anesthesia can be very useful and have many of the desired characteristics of the…”

“…2 Moreover, spinal anesthesia is an important alternative in many patients with comorbidities in whom general anesthesia may be contraindicated. 2 If proper anesthetic agent is used, spinal anesthesia can be very useful and have many of the desired characteristics of the…”