Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Lessing, Noah L; Edwards, Charles C.; Dean, Clayton L.; Waxter, Olive H.; Lin, Charles; Curto, Ryan A.; Brown, Charles H.

doi:10.14444/7103

Cited by 16 publications

(16 citation statements)

References 26 publications

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“…22 All included studies evaluated a combination of postoperative complication rates, total anesthesia time, operative time, blood loss, LOS, postoperative analgesic use, and anesthesia cost. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] In addition to assessing the impact of spinal anesthesia versus general anesthesia across all surgical techniques, we performed subgroup analyses separated by procedure. Our stratified analyses showed that total anesthesia times were significantly shorter in patients who received spinal anesthesia than in those who received general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 14 articles met the inclusion and exclusion criteria from an initial pool of 552 articles. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] All articles evaluated the total intraoperative time, anesthesia duration, postoperative complications, postoperative pain, or a combination thereof. All 14 articles were included in the quantitative analysis and compared the aforementioned outcomes in patients who received general anesthesia with those who received spinal anesthesia and underwent an awake procedure.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

Perez-Roman

Govindarajan

Bryant

et al. 2021

Neurosurgical Focus

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OBJECTIVE Awake surgery has previously been found to improve patient outcomes postoperatively in a variety of procedures. Recently, multiple groups have investigated the utility of this modality for use in spine surgery. However, few current meta-analyses exist comparing patient outcomes in awake spinal anesthesia with those in general anesthesia. Therefore, the authors sought to present an updated systematic review and meta-analysis investigating the utility of spinal anesthesia relative to general anesthesia in lumbar procedures. METHODS Following a comprehensive literature search of the PubMed and Cochrane databases, 14 clinical studies were included in our final qualitative and quantitative analyses. Of these studies, 5 investigated spinal anesthesia in lumbar discectomy, 4 discussed lumbar laminectomy, and 2 examined interbody fusion procedures. One study investigated combined lumbar decompression and fusion or decompression alone. Two studies investigated patients who underwent discectomy and laminectomy, and 1 study investigated a series of patients who underwent transforaminal lumbar interbody fusion, posterolateral fusion, or decompression. Odds ratios, mean differences (MDs), and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of the total anesthesia time showed that time was significantly less in patients who received spinal anesthesia for both lumbar discectomies (MD −26.53, 95% CI −38.16 to −14.89; p = 0.00001) and lumbar laminectomies (MD −11.21, 95% CI −19.66 to −2.75; p = 0.009). Additionally, the operative time was significantly shorter in patients who underwent spinal anesthesia (MD −14.94, 95% CI −20.43 to −9.45; p < 0.00001). Similarly, when analyzing overall postoperative complication rates, patients who received spinal anesthesia were significantly less likely to experience postoperative complications (OR 0.29, 95% CI 0.16–0.53; p < 0.0001). Furthermore, patients who received spinal anesthesia had significantly lower postoperative pain scores (MD −2.80, 95% CI −4.55 to −1.06; p = 0.002). An identical trend was seen when patients were stratified by lumbar procedures. Patients who received spinal anesthesia were significantly less likely to require postoperative analgesia (OR 0.06, 95% CI 0.02–0.25; p < 0.0001) and had a significantly shorter hospital length of stay (MD −0.16, 95% CI −0.29 to −0.03; p = 0.02) and intraoperative blood loss (MD −52.36, 95% CI −81.55 to −23.17; p = 0.0004). Finally, the analysis showed that spinal anesthesia cost significantly less than general anesthesia (MD −226.14, 95% CI −324.73 to −127.55; p < 0.00001). CONCLUSIONS This review has demonstrated the varying benefits of spinal anesthesia in awake spine surgery relative to general anesthesia in patients who underwent various lumbar procedures. The analysis has shown that spinal anesthesia may offer some benefits when compared with general anesthesia, including reduction in the duration of anesthesia, operative time, total cost, and postoperative complications. Large prospective trials will elucidate the true role of this modality in spine surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

Perez-Roman

Govindarajan

Bryant

et al. 2021

Neurosurgical Focus

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“…Intensive care admission and complication rates are lower. Benefits from spinal anesthesia are more evident in geriatric patients and patients with comorbidities ( 9 , 10 ).…”

Section: Regional Anesthesia In Spinal Surgerymentioning

confidence: 99%

Regional Anesthesia in Spinal Surgery: Could it be the Solution for Difficult Intubation

Hasani¹

2022

ACC

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This article includes two topics -anesthesia for spinal surgery and difficult airway, both of them are linked with the same topic, which is regional anesthesia. In recent years, regional anesthesia for spinal surgery has gained a great popularity, where neuraxial blocks are the first choice. Regional anesthesia seems to have benefits against general anesthesia due to lower rate of perioperative and postoperative complications, lower cost and length of stay. This is more evident in elderly population or patients with comorbidities. On the other hand, difficult airway is the life threatening condition and requires increased attention. There are many methods and tools for managing difficult airways, but there are few supporters of regional anesthesia as an option or solution in these cases. Of course, special attention is required during regional anesthesia in a patient with difficult airway, the decision must be correct, and an anesthesiologist must have a preformulated strategy for airway management.However, does not the same happen even when we apply general anesthesia?

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“…[ 20 ] Spinal anesthesia also exposes the patient to increased risk of symptomatic CSF leak on administration and introduces possibilities of infectious and operative complications. [ 34 ] Finally, awake procedures may increase feelings of anxiousness in patients. Anxiousness is usually due to, but not limited to: the thought of being awake, possibly feeling the surgeon, potentially seeing their body cut open, the thought of the numbness wearing off too quickly or that local anesthesia may be more.…”

Section: Advantages and Limitationsmentioning

confidence: 99%

Awake spine surgery: An eye-opening movement

Fiani

Reardon

Selvage

et al. 2021

Surgical Neurology International

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Background: Awake surgery is performed in multiple surgical specialties, but historically, awake surgery in the field of neurosurgery was limited to craniotomies. Over the past two decades, spinal surgeons have pushed for techniques that only require regional anesthesia as they may provide reduced financial burdens on patients, faster recovery times, and better outcomes. The list of awake spine surgeries that have been found in the literature include: laminectomies/discectomies, anterior cervical discectomy and fusions (ACDFs), lumbar fusions, and dorsal column (DC) stimulator placement. Methods: An extensive review of the published literature was conducted through PubMed database with articles containing the search term “awake spine surgery.” No date restrictions were used. Results: The search yielded 293 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Findings have shown that lumbar laminectomies performed with local anesthesia have shown shorter operating time, less postoperative nausea, lower incidence of urinary retention and spinal headache, and shorter hospital stays when compared to those performed under general anesthesia. Lumbar fusions with local anesthesia showed similar outcomes as patients reported better postoperative function and fewer side effects of general anesthesia. DC stimulator placement performed with local anesthesia is advantageous as it allows real time patient feedback for surgeons as they directly test affected nerves. However, spontaneous movement during the placement of DC stimulators is associated with higher failure rates when compared to general anesthesia (29.7% vs. 14.9%). Studies have shown that the use of local anesthesia during ACDFs has no significant differences when compared to general anesthesia, and patient’s report better tolerated pain with general anesthesia. Conclusion: The use of awake spine surgery is beneficial for those who cannot undergo general anesthesia. However, it is limited to patients who can tolerate prone positioning with no central airway (i.e., normal BMI with a healthy airway), have no pre-existing mental health conditions (e.g., anxiety), and require a minimally invasive procedure with a short operating time. Future studies should focus on long-term efficacies of these procedures that provide further insight on the indications and limitations of awake spine surgery.

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Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Cited by 16 publications

References 26 publications

Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients

Regional Anesthesia in Spinal Surgery: Could it be the Solution for Difficult Intubation

Awake spine surgery: An eye-opening movement

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