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

2021 ◽  
Vol 51 (6) ◽  
pp. E7
Author(s):  
Roberto J. Perez-Roman ◽  
Vaidya Govindarajan ◽  
Jean-Paul Bryant ◽  
Michael Y. Wang

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.

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Feeley ◽  
I Feeley ◽  
K Clesham ◽  
J Butler

Abstract Aim Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal; transperitoneal; open; and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. We aim to elucidate the comparative rates of complications across approach type. Method A systematic review of the search databases Pubmed; google scholar; and OVID Medline was made in November 2020 to identify studies related to complications associated with anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Studies eligible for inclusion were agreed by two independent reviewers. Meta-analysis was used to compare intra- and postoperative complications with ALIF for each approach. Results 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of Retrograde Ejaculation (RE) (p &lt; 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI=-0.04-0.07). Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusions Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intra- and postoperative complications, although confounders including use of BMP and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays, however its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.


Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 245-246
Author(s):  
John Thomas Pierce ◽  
Prateek Agarwal ◽  
Paul J Marcotte ◽  
William Charles Welch

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.


Author(s):  
Aoife Feeley ◽  
Iain Feeley ◽  
Kevin Clesham ◽  
Joseph Butler

Abstract Purpose Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type. Methods A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach. Results A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05–0.21) and overall rates of complications (p = 0.05; CI = 0.00–0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI =  − 0.04–0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusion Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.


This case focuses on the effects of neuraxial blockade on postoperative mortality and morbidity by asking the question: What are the effects of neuraxial blockade with epidural or spinal anesthesia on postoperative morbidity and mortality? This systematic review examined all trials with randomization to intraoperative neuraxial blockade (with epidural or spinal anesthesia) or no neuraxial blockade for which data were available before January 1, 1997. The study included 9,559 patients over 141 included trials. Study results demonstrated that neuraxial blockade reduces morbidity and postoperative complications in a wide range of patients, independent of surgery type, choice of neuraxial technique, or use of general anesthesia.


Author(s):  
Eleni Tsiampa ◽  
Eleftherios Spartalis ◽  
Gerasimos Tsourouflis ◽  
Dimitrios Dimitroulis ◽  
Nikolaos Nikiteas

Background/Aim: The purpose of this article is to review the published literature on single-port laparoscopic (SPL) ovarian cystectomy and to assess whether the reduced port number affects the ovarian reserve in comparison with the conventional multiport laparoscopic (MPL) ovarian cystectomy. Materials and methods: Serum anti-Müllerian hormone (AMH) had been proposed as the most accurate marker of ovarian reserve. A review of the current literature was performed based on the preoperative and postoperative AMH after SPL and MPL ovarian cystectomy in adult patients with benign ovarian cysts. Results: Ovarian cystectomy causes a non-statistically significant reduction in AMH levels four weeks postoperatively in the SPL group compared to MPL group[MD=0.11, 95%CI (-0.01, 0.24), p=0.07] . Operative time was significantly longer and blood loss was significantly higher in SPL group. No difference was found to major or overall postoperative complications between the two groups Conclusion: SPL cystectomy recommended as a safe surgical choice for patients who want to preserve their fertility.


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