Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials

Abstract

Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta-analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% CI) with spinal anaesthesia for intra-operative hypertension was 0.31 (0.15-0.64), I = 0% (p = 0.002); for intra-operative tachycardia 0.51 (0.30-0.84), I = 0% (p = 0.009); for analgesic requirement in the postanaesthesia care unit 0.32 (0.24-0.43), I = 0% (p < 0.0001); and for nausea/vomiting within 24 h postoperatively 0.29 (0.18-0.46), I = 12% (p < 0.00001). The standardised mean difference (95% CI) for hospital stay was -1.15 (-1.98 to -0.31), I = 89% (p = 0.007). There was no evidence of a difference in intra-operative hypotension and bradycardia, blood loss, surgical time, analgesic requirement within 24 h postoperatively, and nausea/vomiting in the postanaesthesia care unit. We conclude that spinal anaesthesia appears to offer advantages over general anaesthesia for lumbar spine surgery.

Effects of anesthesia protocol on perioperative outcomes and costs in lumbar microdiscectomies

“…The length of hospital stay has been reported to be shorter in the SA group (10,11), or similar to that of the GA group (4,5,20). The shorter hospitalization times of patients under SA may be because of the lower complication rates.…”

“…Moreover, SA has been reported to be associated with less intraoperative blood loss than GA (3,5,11). A randomized prospective study conducted by Attari et al showed that SA was superior to GA in terms of decreasing intraoperative blood loss and yielding better hemodynamics (2).…”

Type of anesthesia for lumbar spine surgery in prone position

“…Цікаво, що у 2016 та 2017 роках опубліковано два метааналізи, де порівняно використання загальної та регіонарної анестезій під час хірургічних втручань на поперековому відділі хребта з протилежними результатами щодо впливу виду анестезії на рівень крововтрати [7,8]. Причиною розбіжності ми вважаємо вищу частоту інтраопераційної гіпертензії в групі загальної анестезії.…”

Hemodynamics in Different Types of Anesthesia Depending on the Initial Blood Circulation Regime during Spine Surgery in Prone Position

“…During spinal surgeries in prone position, the spinal cord and the optic nerve are considered to be the most vulnerable [2]. Therefore, it is important to predict the possibility of adverse changes in SA [7,8]. Negative effect of general anesthesia based on propofol on hemodynamics is explained by both a direct cardio depressive effect and a decrease in peripheral vascular resistance, which is associated with its mechanism of action called postcapillary venular vasodilation [9].…”