Significantly shorter anesthesia time for surgery of the lumbar spine

Singeisen, H.; Hodel, D.; Schindler, Christoph; Frey, Kathrin; Eichenberger, Urs; Hausmann, Oliver

doi:10.1007/s00101-013-2204-8

Cited by 18 publications

(5 citation statements)

References 23 publications

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“…The perioperative time was as expected significantly longer in the GA group because a patient after SA can be brought back to the ward relatively quickly. This finding stands in accordance to what was reported in previous studies 10 …”

Section: Discussionsupporting

confidence: 94%

Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years

Kindris¹,

Zegarek

Krappel³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Background Context: Decompression or sequestrectomy in the lumbar spine can be performed under general (GA) or regional anesthesia. In elderly patients, it is still not clear, which procedure should be chosen. Objective: To demonstrate that spinal anesthesia (SA) is a safe choice for lumbar decompression or sequestrectomy in elderly patients Design: Retrospective clinical single-center study. Patients Sample: We included 154 patients with ages over 75 years after lumbar decompression or sequestrectomy. The mean age of the patients was 81 years. Outcome Measures: Perioperative data (blood loss, dural tear, operative and perioperative time, delirium, urinary retention, and hospital stay) and the postoperative 1-year follow-up (visual analog scale and complication rate). Patients and Methods: Data were retrospectively collected from patients that underwent lumbar decompression or sequestrectomy between January 2019 and December 2020. The data from the GA and SA groups were compared. Results: SA was performed in 56 patients whereas 98 patients received a GA. There was no clinically relevant difference between both groups with comparable complication rates. The time of surgery, blood loss, perioperative time, and hospital stay time were significantly less in the SA group. Conclusions: SA and GA are both safe and reliable procedures for lumbar decompression or sequestrectomy in elderly patients with no clinically relevant difference.

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Section: Discussionsupporting

confidence: 94%

Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years

Kindris¹,

Zegarek

Krappel³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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show abstract

“…Several studies have compared the use of general anesthesia and spinal anesthesia in spinal procedures in terms of perioperative complication rates, hemodynamic parameters, and operative, anesthesia, and recovery times. 1-15 A majority of these studies observed fewer complications, more favorable hemodynamic parameters, and shorter anesthetic time spent with spinal anesthesia than with general anesthesia, suggesting that this anesthetic modality may even be a superior alternative to the perceived standard of care. 1-11 However, other studies have found no difference in perioperative outcomes between spinal anesthesia and general anesthesia even finding general anesthesia to be superior in some respects, particularly in surgeon satisfaction.…”

Section: Introductionmentioning

confidence: 99%

An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings

Morris

Wallace

et al. 2018

Global Spine Journal

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Study Design: Retrospective chart review. Objective: To determine the relative cost-effectiveness of spinal anesthesia and general anesthesia for lumbar laminectomy and microdiscectomy surgery performed in an academic versus private practice hospital setting. Methods: The authors retrospectively reviewed charts of 188 consecutive patients who underwent lumbar laminectomy or microdiscectomy by a single surgeon from 2012 to 2016 at either an academic or a private practice hospital setting. Intraoperative and postoperative outcomes were recorded and direct variable costs were calculated. Results: At the academic institution, the direct cost of a lumbar laminectomy or microdiscectomy surgery under general anesthesia was determined to be 9.93% greater than with spinal anesthesia ( P = .040). The greatest difference was seen with operating room costs, in which general anesthesia was associated with 18.74% greater costs than spinal anesthesia ( P = .016). There was no significant difference in cost at the private practice hospital setting. Conclusions: We conclude that use of spinal anesthesia for lumbar laminectomy leads to less operating room, postanesthesia care unit, and anesthesia times, lower levels of postoperative pain, and no increased rate of other complications compared with general anesthesia at an academic institution as compared to a private practice setting. Spinal anesthesia is 9.93% less expensive than general anesthesia, indicating substantial cost-saving potential. With no sacrifice of patient outcomes and the added benefit of less pain and recovery time, Spinal anesthesia represents a more cost-effective alternative to general anesthesia in lumbar spine surgery in the academic hospital setting.

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“…There are several considerations to keep in mind while implementing our additional prone dose algorithm. Patients should always be first counseled about the steps involved in spinal anesthesia, and the possibilities for requiring a second dose while prone as well as for ultimately converting to GA. Before administering the first dose of anesthetic, lumbar MRI scans are 12 7 42 Kolcun et al 13 4 544 Pierce et al 9 3.9 625 Walcott et al 6 2.5 81 Lessing et al 14 0 56 Singeisen et al 15 1.9 368 West et al 16 0 34 always reviewed for any abnormal anatomy. At our institution, the anesthesiologist administers the first dose of spinal anesthetic while the patient is sitting upright, and the surgeon provides the second as needed when the patient is positioned prone and already prepped for surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Walcott et al 6 studied a sample of 81 spinal anesthesia patients undergoing diskectomies and posterior decompression of which 2 intraoperative conversions to GA were recorded. Lessing et al 14 conducted a study on 56 spinal anesthesia patients all age 70 years or older who underwent lumbar decompression and fusion procedures, of which there were no reported conversions to GA. Singeisen et al 15 reported a series of 368 spinal anesthesia patients who underwent decompression, diskectomy, and fusions in the prone position with 7 confirmed conversions to GA. West et al 16 described 34 patients undergoing lumbar diskectomy, laminectomy, and fusions under spinal anesthesia of which none required conversion to GA.…”

Section: Discussionmentioning

confidence: 99%

A Second Prone Dose Algorithm for Patients Undergoing Spinal Anesthesia During Thoracolumbar Surgeries

Wang

Olmos

Ahsan

et al. 2022

Operative Neurosurgery

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BACKGROUND:Spinal anesthesia is safe and effective in lumbar surgeries, with numerous advantages over general anesthesia (GA). Nevertheless, 1 major concern preventing the widespread adoption of this anesthetic modality in spine surgeries is the potential for intraprocedural anesthetic failure, resulting in the need to convert to GA intraoperatively.OBJECTIVE:To present a novel additional prone dose algorithm for when a first spinal dose fails to achieve the necessary effect.METHODS:A total of 422 consecutive patients undergoing simple and complex thoracolumbar surgeries under spinal anesthesia were prospectively enrolled into our database. Data were retrospectively collected through extraction of electronic health records.RESULTS:Sixteen of 422 required a second prone dose, of whom 1 refused and was converted to GA preoperatively. After 15 were given a prone dose, only 2 required preoperative conversion to GA. There were no instances of intraoperative conversion to GA. The success rate for spinal anesthesia without the need for conversion rose from 96.4% to 99.5%. In patients who required a second prone dose, there were no instances of spinal headache, deep vein thrombosis, pneumonia, urinary tract infection, urinary retention, readmission within 30 days, acute pain service consult, return to operating room, durotomy, or cerebrospinal fluid on puncture.CONCLUSION:Use of an additional prone dose algorithm was able to achieve a 99.5% success rate, and those who received this second dose did not experience any complications or negative operative disadvantages. Further research is needed to investigate which patients are at increased risk of inadequate analgesia with spinal anesthesia.

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Significantly shorter anesthesia time for surgery of the lumbar spine

Cited by 18 publications

References 23 publications

Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years

Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years

An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings

A Second Prone Dose Algorithm for Patients Undergoing Spinal Anesthesia During Thoracolumbar Surgeries

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