Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases☆
Introduction
General anaesthesia is conventionally and widely used across the globe for spinal surgery. In last decade few centres have tried spinal anaesthesia for lumbar spine surgeries with encouraging results.1, 2, 3, 4, 5, 6, 7 Majority of all the studies of SA on lumbar spine surgeries are on non-instrumented simple surgeries like laminectomy and lumbar discectomy. There is paucity of research on lumbar spine instrumented fusion surgeries in prone position under spinal anaesthesia.
Studies have shown surgery under epidural anaesthesia is associated with less blood loss compared with general anaesthesia.8 We also observed decreased per-operative blood loss in SA group in comparison to GA group. Post operative complications like post op hypoxia, thrombo-embolic episodes, cardiac events, respiratory problems, incidence of nausea -vomiting are less in case of regional anaesthesia.9, 10, 11, 12
SA offers better analgesia in post-op period than GA with lesser analgesic requirement in first 24 h.5
Additional benefit of SA is awake patient can position themselves according to their comfort and chance of brachial plexus injury or eye injury due to prone positioning is almost nil.5
SA is safer anaesthesia for patients with lung, liver and kidney diseases which are not uncommon in older age group. In our experience patients who underwent lumbar spine surgery under SA had less adverse effect in comparison to GA.
Mac Lain et al.4 found higher surgeon and patient satisfaction in lumbar microdiscectomy patients when done under SA in ASA I patients.
Now in the time of Covid-19 pandemic it is advised to avoid tracheal intubation/GA to prevent aerosol generation13 and regional anaesthesia like SA is a better alternative wherever applicable.
Section snippets
Methods
We collected data retrospectively of total two hundred and thirty nine patients operated from January 2014 to December 2019 with American Society of Anaesthesiologist Physical Status (ASA-PS)I, II and III, age ranges from 20 to 79 years. One hundred and thirty one patients were operated under SA and rest one hundred and eight patients were operated under GA. The surgeries performed were single level L4-L5 or L5-S1 TLIF and L4-L5 pedicle screw fixation posterolateral fusion (PLF) and
Discussion
Apart from general anaesthesia regional anaesthesia like SA or epidural anaesthesia have been tried successfully in recent time for lumbar spine non instrumented surgeries. There are very few research on the safety and outcome of spinal anaesthesia for lumbar spine instrumented fusion surgeries.
McLain et al.(3) in a case-controlled study in 400 patients underwent either SA or GA for performing non-instrumented lumbar decompression, showed that SA was as effective as GA.
In our study we have
Conclusion
Our study shows spinal anaesthesia is a potential alternative to GA for lumbar spine instrumented fusion surgeries. SA takes a shorter anaesthesia procedure time and anaesthesia time in comparison to GA where intubation and post surgery reversal time is considerably more. Hence in SA group the operating room time is less. In SA the blood loss is also significantly less. In regional anaesthesia the awake patient can position is head arms as he/she desires,when placed prone on bolsters. So
Declaration of competing interest
No conflict of interest.
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ROLE OF EACH AUTHOR-DR.SAIKAT SARKAR OPERATED ALL THE CASES AND DR.ADITI BANERJI AND DR.ARINDAM CHATTOPDHYAYA WERE THE ANAESTHESIOLOGISTS.WHILE PREPARING THE MANUSCRIPT THE MAIN AUTHOR IS DR.SAIKAT SARKAR.DR.ADITI BANERJI AND DR.ARINDAM CHATTOPADHYAYA HELPED HIM WRITING THE MANUSCRIPT AND DR.SITIKANTHA BANERJEE DID THE ALL STASTICAL ANANLYSIS OF THE DATA.