Spinal versus general anaesthesia for lumbar spine surgery: patient characteristics and economic aspects

Hodel, D.; Singeisen, Hélène; Frey, Kere; Schindler, Christoph; Eichenberger, Urs; Hausmann, Oliver

doi:10.1097/00003643-201306001-00402

Cited by 2 publications

(2 citation statements)

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“…The findings of these studies, along with multi-procedure data sets, are shown in [ Table 4 ]. [ 23 , 28 , 51 ] Historically, patients with multiple comorbidities and received an ASA score of III or IV were deemed ineligible for spinal procedures under general anesthesia. However, following patient cases with an ASA of III or IV, Khan et al .…”

Section: Indicationsmentioning

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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Section: Indicationsmentioning

confidence: 99%

Awake spine surgery: An eye-opening movement

Fiani

Reardon

Selvage

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

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“…Patients usually favor GA due to being completely pain-free during the operation (6). Also, many surgeons may refuse regional anesthesia (RA) mostly due to fear of infection and inability to evaluate neural damage during operation as RA causes sensory and /or motor block (7,8). Decreased venous pressure resulting from RA may reduce blood loss and improve surgical field, and consequently, shorten surgery time and decrease the comorbidities of prolonged surgical time.…”

Section: Contextmentioning

confidence: 99%

Comparison of the Economic Outcomes of Neuroaxial and General Anesthesia for Lumbar Spine Operations: A Systematic Review and Meta-Analysis

et al. 2019

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Context: Lumbar spine operations can be safely performed under general or neuroaxial anesthesia, but there are controversies as to the clinical outcomes and cost benefits of each method. The goal of this systematic review and meta-analysis was to determine the advantages of each technique (i.e., regional or general anesthesia) for lumbar spine surgery with regards to cost, duration of surgery, duration of post anesthesia care unit, and duration of hospital stay. Data Sources: We conducted a systematic search for articles comparing regional anesthesia (RA) versus general anesthesia (GA) for lumbar spine surgery using three major databases (i.e., PubMed, EMBASE, and Google Scholar), without limitation for date and language of publication. We also manually double checked the references of all the related articles to detect missed articles by electronic searching. The last search was performed before September 2018; the quality of the included articles was assessed by different checklists according to the type of the article. STATA software (V. 10) was used for performing meta-analysis. Results: Twenty-eight articles were included in this meta-analysis. Cost data were presented in seven studies and reported a significant decrease in the cost of treatment in RA patients compared with GA patients. The standard mean difference (SMD) (95% CI) for cost was 1.64 (1.53 to 1.75); z = 29.17; P < 0.001; I 2 = 98.9. Surgical time data were presented in 25 studies, which reported significant reduction in the surgery time in RA patients compared with GA patients, the SMD (95% CI) for surgery time was 0.77 (0.71 to -0.84); z = 23.9; P < 0.001; I 2 = 97.9. Post anesthesia care unit (PACU) stay data were presented in 16 studies and reported significant increase in PACU stay in RA patients compared with GA patients. The SMD (95% CI) for PACU stay time was -0.4 (-0.49 to -0.31); z = 8.65; P < 0.001; I 2 = 99.2. Hospital stay data were presented in 18 studies and reported significant decrease in hospital stay time in RA patients compared with GA patients. The SMD (95% CI) for hospital stay time was 0.76 (0.68 to 0.84); z = 18.81.; P < 0.001; I 2 = 98.3. Egger and Begg's tests showed no significant publication bias. Conclusions: This comprehensive systematic review showed that RA has several advantages over GA with respect to cost, surgery time, and duration of hospital stay in patients undergoing lumbar spine surgery, while increase in PACU stay time was observed in RA patients.

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Spinal versus general anaesthesia for lumbar spine surgery: patient characteristics and economic aspects

Cited by 2 publications

References 0 publications

Awake spine surgery: An eye-opening movement

Awake spine surgery: An eye-opening movement

Comparison of the Economic Outcomes of Neuroaxial and General Anesthesia for Lumbar Spine Operations: A Systematic Review and Meta-Analysis

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