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Boykov N, Ferdinandov D, Vasileva P, Yankov D, Burev S, Tanova R. Thoracic spinal anesthesia with intrathecal sedation for lower back surgery: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1387935. [PMID: 38665296 PMCID: PMC11043566 DOI: 10.3389/fmed.2024.1387935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Background Spinal anesthesia (SA) is a good alternative to general anesthesia (GA) for spine surgery. Despite that, a few case series concern the use of thoracic spinal anesthesia for short-duration surgical interventions. In search of an alternative approach to GA and a better opioid-free modality, we aimed to investigate the safety, feasibility, and patient satisfaction of thoracic SA for spine surgery. Materials and methods We analyzed retrospectively a cohort of 24 patients operated on for a degenerative and osteoporotic pathology of the lower thoracic and lumbar spine. Data was collected from medical records, including clinical notes, operative and anesthesia records, and patient questionnaires. Results Twenty-one surgeries for herniated discs, two for degenerative spinal stenosis, and one for multi-level osteoporotic vertebral body fractures were performed under spinal anesthesia with intrathecal sedation. In all cases, we applied 0.5% isobaric bupivacaine and the following adjuvants: midazolam, clonidine or dexmedetomidine, and dexamethasone. We boosted the anesthesia with local ropivacaine due to inefficient sensory block in two patients. Nobody in the cohort received intravenous opioids, non-steroidal anti-inflammatory drugs, or additional sedation intraoperatively. Postoperative painkillers were upon the patient's request. No significant complications were detected. Conclusion Thoracic spinal anesthesia incorporating adjuvants such as midazolam, clonidine or dexmedetomidine, and dexamethasone demonstrates not only efficient conditions for spine surgery, a favorable safety profile, high patient satisfaction, and intrathecal sedation but also effective opioid-free pain management.
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Affiliation(s)
- Nikolay Boykov
- Department of Anesthesiology and Intensive Care, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dilyan Ferdinandov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Petra Vasileva
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dimo Yankov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Burev
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Rositsa Tanova
- Department of Anesthesiology and Intensive Care, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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Koutp A, Hauer G, Leitner L, Kaltenegger L, Fischerauer S, Clar C, Reinbacher P, Schittek G, Leithner A, Sadoghi P. Less Induction Time and Postoperative Pain Using Spinal Anesthesia Versus General Anesthesia With or Without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:904-909. [PMID: 37852447 DOI: 10.1016/j.arth.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect. METHODS Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients). RESULTS We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05). CONCLUSIONS Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
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Affiliation(s)
- Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lucas Kaltenegger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefan Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Clemens Clar
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gregor Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Rajjoub R, Ghaith AK, El-Hajj VG, Rios-Zermano J, De Biase G, Atallah E, Tfaily A, Saad H, Akinduro OO, Elmi-Terander A, Abode-Iyamah K. Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:985-1000. [PMID: 38110776 DOI: 10.1007/s00586-023-08071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic. METHODS A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models. RESULTS In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): - 0.40 days; 95% CI - 0.64 to - 0.17) and operative time (MD: - 19.17 min; 95% CI - 29.68 to - 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI 0.37-0.99]). CONCLUSIONS Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Victor Gabriel El-Hajj
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ali Tfaily
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Kingsley Abode-Iyamah
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Chowdary AR, Beale J, Martinez J, Aggarwal V, Mounasamy V, Sambandam S. Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:5615-5621. [PMID: 37061659 DOI: 10.1007/s00402-023-04876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.
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Affiliation(s)
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Jack Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Vikram Aggarwal
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.
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Aljaffary A, AlAnsari F, Alatassi A, AlSuhaibani M, Alomran A. Assessing the Precision of Surgery Duration Estimation: A Retrospective Study. J Multidiscip Healthc 2023; 16:1565-1576. [PMID: 37309537 PMCID: PMC10257906 DOI: 10.2147/jmdh.s403756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
Background and Objectives The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy. Methods This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software. Results Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p <0.05) in their OR estimation. Conclusion Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement. Recommendations It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.
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Affiliation(s)
- Afnan Aljaffary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah AlAnsari
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaleem Alatassi
- Preoperative Quality and Patient Safety Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed AlSuhaibani
- Operating Room Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ammar Alomran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Daneshi SA, Nabiuni M, Taheri M, Pour Roustaei Ardekani R. Spinal Versus General Anesthesia for Spine Surgery During the COVID-19 Pandemic: A Case Series. Anesth Pain Med 2023; 13:e134783. [PMID: 37601956 PMCID: PMC10439686 DOI: 10.5812/aapm-134783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Hospitals are one of the primary resources for disease transmission, so many guidelines were published, and neurosurgeons were advised to postpone elective spine surgeries during the COVID-19 pandemic. Objectives To avoid pulmonary complications and reduce the risk of spreading the virus and contracting the disease during the COVID-19 era, we operated a group of our patients under spinal anesthesia rather than general anesthesia. Methods We retrospectively analyzed all patients who underwent discectomy surgery for lumbar spinal disc herniation under SA between September 2020 and 2021. Results Sixty-four patients diagnosed with lumbar disc herniation underwent lumbar discectomy with SA. All patients except three were male. The mean age was 44.52 ± 7.95 years (28 to 64 years). The mean procedure time for SA was 10 minutes. The duration of the surgery was 40 to 90 minutes per each level of disc herniation. The mean blood loss was 350 cc (200 to 600 cc). The most common involved level was L4/L5 intervertebral disc (n = 40 patients; 63.5%). The mean recovery time was 20 minutes. Only three patients requested more analgesics for relief of their pain postoperatively. All patients with discectomy were discharged a day after surgery, and in the case of fusion, two days after surgery. All the patients were followed up for six months, showing no recurrence symptoms, good pain relief, satisfaction with the surgery, and no bad memory of the surgery. Conclusions Spinal anesthesia is a good alternative or even the main anesthesia route for patients with lumbar disc herniation. More studies are needed to elucidate the best candidate for SA in patients with lumbar pathology.
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Affiliation(s)
| | - Mohsen Nabiuni
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Taheri
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
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7
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Wang AY, Olmos M, Ahsan T, Kanter M, Liu P, Balonov K, Riesenburger RI, Kryzanski J. A Second Prone Dose Algorithm for Patients Undergoing Spinal Anesthesia During Thoracolumbar Surgeries. Oper Neurosurg (Hagerstown) 2023; 24:283-290. [PMID: 36701492 PMCID: PMC10158911 DOI: 10.1227/ons.0000000000000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023] Open
Abstract
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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Affiliation(s)
- Andy Y. Wang
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Tameem Ahsan
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Penny Liu
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Konstantin Balonov
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ron I. Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
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Neurosurgical Anesthesia: Optimizing Outcomes with Agent Selection. Biomedicines 2023; 11:biomedicines11020372. [PMID: 36830909 PMCID: PMC9953550 DOI: 10.3390/biomedicines11020372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
Anesthesia in neurosurgery embodies a vital element in the development of neurosurgical intervention. This undisputed interest has offered surgeons and anesthesiologists an array of anesthetic selections to utilize, though with this allowance comes the equally essential requirement of implementing a maximally appropriate agent. To date, there remains a lack of consensus and official guidance on optimizing anesthetic choice based on operating priorities including hemodynamic parameters (e.g., CPP, ICP, MAP) in addition to the route of procedure and pathology. In this review, the authors detail the development of neuroanesthesia, summarize the advantages and drawbacks of various anesthetic classes and agents, while lastly cohesively organizing the current literature of randomized trials on neuroanesthesia across various procedures.
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Sowers M, Jacob R, Chandler K, Kuntz GE, Rajaram S, Kukreja P, Naranje S. Operative room time comparison between general and spinal anesthesia in total hip arthroplasty: an institutional study. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04775-4. [PMID: 36695906 DOI: 10.1007/s00402-023-04775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE A relatively high expense with any procedure is total operative time; two components being the time spent anesthetizing the patient and time spent transferring the patient out of the operating room (OR). Both times can be affected by the anesthetic method used. This study compares different operative time intervals for both spinal anesthesia (SA) and general anesthesia (GA), in patients undergoing a primary total hip arthroplasty (THA), to identify the most appropriate and cost-effective anesthetic method. METHODS A retrospective chart review was performed at a single institution for primary total hip arthroplasty procedures performed in the year 2019. Primary THAs without complications performed by three orthopedic surgeons were selected. Anesthesia records for 200 patients were used to compare perioperative time intervals; 100 consecutive patients that received SA and 100 consecutive patients that received GA. RESULTS The time spent transferring the patient out of the operating room was 8 min for GA and 5 min for SA (p < 0.001). Total operative time for GA was 90 min and 87 min for SA (p = 0.3330). Total pre-operative time averaged 26 min in SA compared to 25 min in GA (p = 0.5874). Non-operative total time (all time components of patient interaction excluding surgery start to surgery finish) was significantly shorter in SA with an average of 52 compared to 56 in GA (p = 0.0151). CONCLUSION Time to transfer patient out of the OR and total non-operative time was significantly shorter in patients who received spinal anesthesia. These results and the complications of both general and spinal anesthesia should be taken into consideration when anesthetizing patients undergoing primary THA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mackenzie Sowers
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Roshan Jacob
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Kelly Chandler
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - George E Kuntz
- Department of Anesthesiology, University of Alabama at Birmingham, JT 845 619 South 19th Street, Birmingham, AL, 35249, USA
| | - Sakthivel Rajaram
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Promil Kukreja
- Department of Anesthesiology, University of Alabama at Birmingham, JT 845 619 South 19th Street, Birmingham, AL, 35249, USA
| | - Sameer Naranje
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA.
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Muacevic A, Adler JR, Akhtar Khan S, Hussain M, Ahmed U. Degenerative Lumbar Spine Surgeries Under Regional Anesthesia in a Developing Country: An Initial Case Series. Cureus 2023; 15:e34065. [PMID: 36843830 PMCID: PMC9943688 DOI: 10.7759/cureus.34065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Current evidence from developed countries on lumbar spine surgeries under regional anesthesia reports it to be superior to general anesthesia (GA) in terms of decreased anesthesia time, operative time, intraoperative complications such as bleeding, postoperative complications, length of hospital stay, and overall cost. We report the first case series from Pakistan on lumbar spine surgeries under regional anesthesia. Methods We utilized spinal anesthesia (SA) for lumbar spine surgeries of 45 patients in a tertiary-care hospital in Karachi, Pakistan. The surgeries were performed as day-care procedures. The preoperative assessments included MRI findings, visual analogue scale (VAS), pre-operative limb powers, and straight leg raise (SLR). Other assessments included total SA time, total surgical time, time of stay in the post-anesthesia care unit (PACU), complications, and total hospital cost. SPSS v26 was used to calculate means and standard deviations. Results We found the total SA time to be about 45 to 60 minutes in most patients (95.6%). The total surgical time was 30 to 45 minutes for most patients. The average time of stay in the PACU was three to four hours. The VAS scores were significantly improved postoperatively with 46.7% (n=21) of patients with a score of 3, 46.7% (n=21) with a score of 2, and 6.7% (n=3) with a score of 1. 71.1% (n=32) patients had day-care surgery, 22.2% (n=10) stayed in the hospital for one day, and 6.7% (n=3) patients stayed for more than one day. Most patients (88.9%, n=40) had no complications, whereas only 11.1% (n=5) complained of PDPH. The total hospital cost was also lesser than procedures under GA. Conclusion We conclude that SA is well tolerated and has favorable outcomes in terms of cost-effectiveness, anesthesia time, surgical time, and hospital stay; therefore, SA should be considered for a greater number of lumbar spine surgeries, especially in low-middle income countries.
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Azad TD, Alomari S, Khalifeh JM, Ahmed AK, Musharbash FN, Mo K, Lubelski D, Witham TF, Bydon A, Theodore N. Adoption of awake spine surgery - trends from a national registry over 14 years. Spine J 2022; 22:1601-1609. [PMID: 35525378 DOI: 10.1016/j.spinee.2022.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Awake spine surgery is growing in popularity, and may facilitate earlier postoperative recovery, reduced cost, and fewer complications than spine surgery conducted under general anesthesia (GA). However, trends in the adoption of awake (ie, non-GA) spine surgery have not been previously studied. PURPOSE To investigate temporal trends in non-GA spine surgery utilization and outcomes in the United States. STUDY DESIGN/SETTING A retrospective observational study. PATIENT SAMPLE Patients undergoing cervical or lumbar decompression or/and fusion from the American College of Surgeons National Surgical Quality Improvement Program database records dated 2005-2019. OUTCOME MEASURES The primary outcome was the adoption trends of awake cervical and lumbar spine operations from 2005 to 2019. The secondary outcomes included the outcomes trends of 30-day complications, readmission rates, and length of stay in cervical and lumbar spine operations from 2005 to 2019. METHODS Patients were stratified into two groups: GA and non-GA (regional, epidural, spinal, monitored anesthesia care/intravenous sedation). Pearson chi-square or Fisher exact test and independent-sample t test were used to compare demographics between groups. Jonckheere-Terpstra test was used to determine whether trends and outcomes of non-GA operations from 2005 to 2019 were statistically significant. No non-GA spine operations were reported in the database from 2005 to 2006. RESULTS We included 301,521 patients who underwent cervical or lumbar spine operations from 2005 to 2019. GA was used in 294,903 (97.8%) operations; 6,618 (2.2%) operations were non-GA. Patients in the non-GA cohort were more likely to be younger (50.1 vs 57.2 years; p<.001), less likely to have American Society of Anesthesiologists classification ≥3 (39.7% vs 48.3%; p<.001), and to have lower BMI (27.8 vs 31.5 kg/m2; p<.001), outpatient admission status (10.8% vs 4.0%; p<.001), and fewer bleeding disorders (0.0% vs 1.2%; p<.001). The proportion of non-GA spine operations increased from nearly 0% in 2005 to 2.1% in 2019. The increase in non-GA operations was statistically significant in cervical (0.0%-1.1%) and lumbar (0.0%-2.9%) operations. For non-GA lumbar operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (19.1%-5.4%, p<.05; 5.9%-2.8%, p<.05; 30.9 hours-24.9 hours, p<.05, respectively). Similarly, for non-GA cervical operations performed 2007-2019, 30-day complication rates, readmission rates, and mean length of stay all decreased (20.1%-6.1%, p<.05; 6.7%-3.7%, p<.05; 27.0-20.0 hours p<.05, respectively). CONCLUSIONS Our trends analysis revealed increasing utilization and improved outcomes of non-GA spine surgery from 2005 to 2019; however, the proportion of non-GA spine operations remains small. Future research should investigate the barriers to adoption of non-GA spine surgery.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Jawad M Khalifeh
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Farah N Musharbash
- Department of Orthopedic Surgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Kevin Mo
- Department of Orthopedic Surgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, 600 N. Wolfe St, Meyer 7-113, Baltimore, 21287, MD, USA.
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Hasani A. REGIONAL ANESTHESIA IN SPINAL SURGERY: COULD IT BE THE SOLUTION FOR DIFFICULT INTUBATION. Acta Clin Croat 2022; 61:129-134. [PMID: 36824630 PMCID: PMC9942463 DOI: 10.20471/acc.2022.61.s2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
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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Affiliation(s)
- Antigona Hasani
- ConsultantProfessor of Anesthesiology and Reanimation, Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Pristina, Pristina, Kosovo
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13
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Ní Eochagáin A, Singleton BN, Moorthy A, Buggy DJ. Regional and neuraxial anaesthesia techniques for spinal surgery: a scoping review. Br J Anaesth 2022; 129:598-611. [PMID: 35817613 DOI: 10.1016/j.bja.2022.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/02/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Whilst general anaesthesia is commonly used to undertake spine surgery, the use of neuraxial and peripheral regional anaesthesia techniques for intraoperative and postoperative analgesia is an evolving practice. Variations in practice have meant that it is difficult to know which modalities achieve optimal outcomes for patients undergoing spinal surgery. Our objective was to identify available evidence on the use of regional and neuraxial anaesthesia techniques for adult patients undergoing spinal surgery. METHODS This study was conducted using a framework for scoping reviews. This included a search of six databases searching for articles published since January 1980. We included studies that involved adult patients undergoing spinal surgery with regional or neuraxial techniques used as the primary anaesthesia method or as part of an analgesic strategy. RESULTS Seventy-eight articles were selected for final review. All original papers were included, including case reports, case series, clinical trials, or conference publications. We found that general anaesthesia remains the most common anaesthesia technique for this patient cohort. However, regional anaesthesia, especially non-neuraxial techniques such as fascial plane blocks, is an emerging practice and may have a role in terms of improving postoperative pain relief, quality of recovery, and patient satisfaction. In comparison with neuraxial techniques, the popularity of fascial plane blocks for spinal surgery has significantly increased since 2017. CONCLUSIONS Regional and neuraxial anaesthesia techniques have been used both to provide analgesia and anaesthesia for patients undergoing spinal surgery. Outcome metrics for the success of these techniques vary widely and more frequently use physiological outcome metrics more than patient-centred ones.
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Affiliation(s)
- Aisling Ní Eochagáin
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Barry N Singleton
- Department of Anaesthesiology, Cork University Hospital, Cork, Ireland
| | - Aneurin Moorthy
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland
| | - Donal J Buggy
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Outcomes Research Consortium, Cleveland, OH, USA; EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group, Rue des Comédiens, Brussels, Belgium
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Yang MJ, Riesenburger RI, Kryzanski JT. The use of intra-operative navigation during complex lumbar spine surgery under spinal anesthesia. Clin Neurol Neurosurg 2022; 215:107186. [DOI: 10.1016/j.clineuro.2022.107186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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Perez-Roman RJ, Govindarajan V, Bryant JP, Wang MY. Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg Focus 2021; 51:E7. [PMID: 34852320 DOI: 10.3171/2021.9.focus21464] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
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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Vora M, Samineni AV, Sing D, Salavati S, Tornetta P. Spinal Anesthesia Associated With Increased Length of Stay Compared to General Anesthesia for Ankle Open Reduction Internal Fixation: A Propensity-Matched Analysis. J Foot Ankle Surg 2021; 60:350-353. [PMID: 33461921 DOI: 10.1053/j.jfas.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
General and spinal anesthesia are both utilized for patients undergoing open reduction internal fixation of the ankle, but there are little data comparing early complication rates. The purpose of this study was to compare duration of surgery, length of stay, and rates of postoperative adverse events within 30 days in patients undergoing open reduction internal fixation of ankle fracture using spinal versus general anesthesia. Adult patients who underwent open reduction internal fixation of a closed ankle fracture from 2012 to 2016 were retrospectively identified from American College of Surgeons National Surgical Quality Improvement Program. Duration of surgery, length of stay, 30-day adverse events, and unplanned readmissions were compared between patients who received general anesthesia and spinal anesthesia. Propensity adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients. Of the 10,795 patients included after applying the inclusion and exclusion criteria, 9862 (91.36%) received general anesthesia and 933 (8.64%) received spinal anesthesia. Using propensity-scored matching, 841 patients in the spinal cohort were matched to 3364 patients in the general cohort. Spinal anesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval 0.23-0.77, p < .001). There were no differences in the rates of major/minor complications, mortality, transfusions, unplanned readmissions, or duration of surgery. General anesthesia is predominantly used for fixation of ankle fractures. While spinal anesthesia is associated with lower complication rates in hip and knee surgery, we found that it is associated with increased length of stay in patients undergoing open reduction internal fixation of the ankle within 30 days of surgery.
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Affiliation(s)
- Molly Vora
- Medical Student, Boston University School of Medicine, Boston, MA
| | | | - David Sing
- Resident, Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
| | - Seroos Salavati
- Anesthesiologist, Director of Regional Anesthesiology, Assistant Professor, Boston Medical Center, Boston, MA
| | - Paul Tornetta
- Orthopaedic Surgeon, Chief, Chair, and Professor of Orthopaedic Surgery, Boston Medical Center, Boston, MA
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Nail TJ, Dowd RS, Liu P, Balonov K, Kryzanski J. Single-center series report of transforaminal lumbar interbody fusions under spinal anesthesia. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fiani B, Reardon T, Selvage J, Dahan A, El-Farra MH, Endres P, Taka T, Suliman Y, Rose A. Awake spine surgery: An eye-opening movement. Surg Neurol Int 2021; 12:222. [PMID: 34084649 PMCID: PMC8168649 DOI: 10.25259/sni_153_2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
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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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Jacob Selvage
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Alden Dahan
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Mohamed H El-Farra
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Philine Endres
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Taha Taka
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Yasmine Suliman
- School of Medicine, University of California Riverside, Riverside, California, United States
| | - Alexander Rose
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
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Ritz ML, Rosenfeld DM, Spangehl M, Misra L, Khurmi N, Butterfield RJ, Buras MR, Gorlin AW. Evaluation of the use of spinal anesthesia administered prior to proceeding to the operating room in patients undergoing total joint arthroplasty. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.pcorm.2020.100154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Awake minimally invasive transforaminal lumbar interbody fusion with a pedicle-based retraction system. Clin Neurol Neurosurg 2020; 200:106313. [PMID: 33139086 DOI: 10.1016/j.clineuro.2020.106313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recently there has been increasing interest in the use of regional anesthesia for minimally-invasive transforaminal lumbar interbody fusion (TLIF) and laminectomy, with the goal of reducing the side effects and risks associated with general anesthesia and also to improve patient satisfaction. The goal of this technical note is to describe important perioperative aspects to safely perform an awake spine surgery and to describe a novel technique to preform minimally-invasive TLIF using a pedicle-based retraction system. METHODS We report our patient selection criteria, perioperative anesthesia protocol and surgical technique for awake TLIF with the Maximum Access Surgery (MAS) TLIF Retraction System. We describe an illustrative case of a 66-year-old female that presented with leg pain, lumbar MRI revealed a grade one spondylolisthesis at L4-5 with severe canal stenosis. She underwent a L4-5 Awake MIS TLIF using the MAS TLIF Retraction System. RESULTS The first 10 awake TLIF we performed with the MAS TLIF Retraction System had a mean procedure time of 117.3 min with a standard deviation (SD) of 13, and a mean total OR time of 151 min, SD 14.5. No surgery was converted under general anesthesia. No intraoperative complications were reported. Average length of stay was 1.3 ± 0.46 days. CONCLUSION Awake MAS TLIF is a safe and effective technique, with the advantage of reducing the risk and side effect of general anesthesia and the approach-associated damage to soft tissues and morbidity. The pedicle-based distraction allows easier access to the intervertebral disc space for both disc preparation and cage placement.
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21
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Iorio-Morin C, Hodaie M, Sarica C, Dea N, Westwick HJ, Christie SD, McDonald PJ, Labidi M, Farmer JP, Brisebois S, D'Aragon F, Carignan A, Fortin D. Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation. Neurosurgery 2020; 87:E178-E185. [PMID: 32335684 PMCID: PMC7188127 DOI: 10.1093/neuros/nyaa157] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery Department of Surgery Université de Sherbrooke Centre hospitalier universitaire de Sherbrooke Sherbrooke, Québec, Canada
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Nicolas Dea
- Division of Neurosurgery Department of Surgery University of British Columbia Blusson Spinal Cord Center Vancouver, British Columbia, Canada
| | - Harrison J Westwick
- CIUSSS du Nord de l'Ile de Montréal Hôpital de Sacré-Coeur de Montréal Montréal, Québec, Canada
| | - Sean D Christie
- Division of Neurosurgery Department of Surgery Dalhousie University Halifax, Nova Scotia, Canada
| | - Patrick J McDonald
- Division of Neurosurgery Department of Surgery University of British Columbia BC Children's Hospital Vancouver, British Columbia, Canada
| | - Moujahed Labidi
- Division of Neurosurgery Department of Surgery Centre hospitalier de l'Université de Montréal Montréal, Québec, Canada
| | - Jean-Pierre Farmer
- Division of Neurosurgery Department of Pediatric Surgery McGill University The Montreal Children's Hospital Montréal, Québec, Canada
| | - Simon Brisebois
- Division of Otolaryngology-Head & Neck Surgery Department of Surgery Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases Université de Sherbrooke Sherbrooke, Québec, Canada
| | - David Fortin
- Division of Neurosurgery Department of Surgery Université de Sherbrooke Centre hospitalier universitaire de Sherbrooke Sherbrooke, Québec, Canada
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Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, Jouffroy L, Herman-Demars H, Bonnet F. Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study. Adv Ther 2020; 37:541-551. [PMID: 31828611 PMCID: PMC6979446 DOI: 10.1007/s12325-019-01172-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 12/13/2022]
Abstract
Introduction This observational study was designed to assess the use of spinal anesthesia with chloroprocaine in the context of ambulatory surgery. Methods A prospective, multicenter, observational study was carried out among 33 private or public centers between May 2014 and January 2015 and adult patients, scheduled for a short ambulatory surgery under spinal anesthesia with chloroprocaine. The primary outcomes were anesthetic effectiveness, defined as performance of the whole surgical procedure without any additional anesthetic agent, and the time to achieve eligibility for hospital discharge. Secondary outcomes were the effect of chloroprocaine on motor and sensory blocks, patients’ satisfaction, and the use of analgesics in the first 24 h after surgery. Results Among the 615 enrolled patients, 56% were male, the mean age was 47.2 ± 15.2 years, and most patients had an ASA (American Society of Anesthesiologists) status of 1 (63.7%). Main surgical procedures performed were orthopedic (62.6%) and gynecologic (16.1%), and the mean duration of surgery was 26.7 ± 16.7 min. The overall anesthetic success rate was 93.8% (95% CI [91.5%; 95.6%]) for the 580 patients with available data for primary criteria. The failure rate was lower than 7% for all surgical procedures, except for gynecologic surgery (14.8%; 95% CI [8.1%; 23.9%]). The average times of eligibility for hospital discharge and effective discharge were 252.7 ± 82.7 min and 313.8 ± 109.9 min, respectively. The time of eligibility for hospital discharge is defined as the recovery of the patient’s normal clinical parameters and the time of effective discharge is defined as the time for the patient to leave the hospital after surgery. Eligibility for patient’s discharge was achieved more rapidly in private than public hospitals (236.3 ± 77.2 min vs. 280.9 ± 80.7 min, respectively, p < 0.001). Conclusions This study showed positive results on the effectiveness of chloroprocaine as a short-duration anesthetic and could be used to reduce the time to achieve eligibility for hospital discharge. Trial Registration ClinicalTrials.gov identifier, NCT02152293. Registered on May 6, 2014. Date of enrollment of the first participant in the trial May 7, 2014.
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Regional Versus General Anesthesia: Effect of Anesthetic Techniques on Clinical Outcome in Lumbar Spine Surgery: A Prospective Randomized Controlled Trial. J Neurosurg Anesthesiol 2020; 32:29-35. [DOI: 10.1097/ana.0000000000000555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Dashtbani M, Dori MM, Hassani M, Omidi-Kashani F. A Survey on the Short-term Outcome of Microlumbar Discectomy with General versus Spinal Anesthesia. Clin Orthop Surg 2019; 11:422-426. [PMID: 31788165 PMCID: PMC6867920 DOI: 10.4055/cios.2019.11.4.422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Surgery on the lower thoracic and lumbosacral spine is possible with both general and spinal anesthesia, but most spine surgeons are reluctant to perform the surgery with spinal anesthesia. We aimed to conduct a survey on the short-term outcome of microlumbar discectomy in the patients who had been treated under general or spinal anesthesia. Methods In this prospective study, we performed a survey on 72 patients who underwent microlumbar discectomy under general anesthesia (group A) or spinal anesthesia (group B). Demographic characteristics, American Society of Anesthesiologists physical status, duration of operation, blood loss, and complications were all documented. Preoperative and early postoperative (at the time of discharge) disability and pain were assessed by using Japanese Orthopedic Association (JOA) scoring system and a visual analog scale questionnaire. Results The two groups were homogenous preoperatively. The mean intraoperative blood loss was less and the mean operating time was shorter in group A than in group B, but there was no statistically significant difference between groups. The rate of postoperative improvement in JOA score and improvement in pain were similar between groups. Anesthetic complications were unremarkable. Conclusions Simple lumbar disc operations in the otherwise healthy patients can be safely performed under either spinal or general anesthesia. Both anesthetic methods led to comparable outcomes with minimal complications.
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Affiliation(s)
- Mohsen Dashtbani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Mokaram Dori
- Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Omidi-Kashani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Comparison of the Economic Outcomes of Neuroaxial and General Anesthesia for Lumbar Spine Operations: A Systematic Review and Meta-Analysis. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.89989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Deng H, Coumans JV, Anderson R, Houle TT, Peterfreund RA. Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience. PLoS One 2019; 14:e0217939. [PMID: 31194777 PMCID: PMC6563985 DOI: 10.1371/journal.pone.0217939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVE Anesthesiologists at our hospital commonly administer spinal anesthesia for routine lumbar spine surgeries. Anecdotal impressions suggested that patients received fewer anesthesia-administered intravenous medications, including vasopressors, during spinal versus general anesthesia. We hypothesized that data review would confirm these impressions. The objective was to test this hypothesis by comparing specific elements of spinal versus general anesthesia for 1-2 level open lumbar spine procedures. DESIGN Retrospective single institutional study. SETTING Academic medical center, operating rooms. PATIENTS Consecutive patients (144 spinal and 619 general anesthesia) identified by automatic structured query of our electronic anesthesia record undergoing lumbar decompression, foraminotomy or microdiscectomy by one surgeon under general or spinal anesthesia. INTERVENTIONS Spinal or general anesthesia. MEASUREMENTS Numbers of medications administered during the case. MAIN RESULTS Anesthesiologists administered in the operating room a total of 10 ± 2 intravenous medications for general anesthetics and 5 ± 2 medications for spinal anesthetics (-5, 95% CI -5 to -4, p<0.001, univariate analysis). Multivariable analysis supported this finding (spinal versus general anesthesia: -4, 95% CI -5 to -4, p<0.001). Spinal anesthesia patients were less likely to receive ephedrine, or phenylephrine (by bolus or by infusion) (all p<0.001, Chi-squared test). Spinal anesthesia patients were also less likely to receive labetolol or esmolol (both p = 0.002, Fishers' Exact test). No neurologic injuries were attributed to, or masked by, spinal anesthesia. Three spinal anesthetics failed. CONCLUSIONS For routine lumbar surgery in our cohort, spinal compared to general anesthesia was associated with significantly fewer drugs administered during a case and less frequent use of vasoactive agents. Safety implications include greater hemodynamic stability with spinal anesthesia along with reduced risks for medication error and transmission of pathogens associated with medication administration.
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Affiliation(s)
- Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jean-Valery Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richard Anderson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Timothy T. Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Robert A. Peterfreund
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Wahood W, Yolcu Y, Alvi MA, Goyal A, Long TR, Bydon M. Assessing the differences in outcomes between general and non-general anesthesia in spine surgery: Results from a national registry. Clin Neurol Neurosurg 2019; 180:79-86. [DOI: 10.1016/j.clineuro.2019.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
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Abstract
BACKGROUND The optimal anesthetic technique remains debated in patients undergoing total-hip arthroplasty (THA). The purpose of this meta-analysis was to test the efficacy of general and spinal anesthesia for patients undergoing THA. METHODS In January 2018, we searched PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) that compared the use of general and spinal anesthesia for patients undergoing THA were retrieved. The primary outcome was to compare the total blood loss. The secondary outcomes were the occurrence of deep venous thrombosis (DVT), the occurrence of nausea, and the length of hospital stay. Software Stata 12.0 was used for meta-analysis. RESULTS Five RCTs with 487 THAs were finally included for meta-analysis. There was no significant difference between the general anesthesia and spinal anesthesia in terms of the total blood loss (weighted mean difference [WMD] = -20.72, 95% confidence interval [CI] -84.50 to 43.05, P = .524; I = 87.8%) and the occurrence of DVT (risk ratio (RR) = 0.85, 95% CI 0.24-3.01, P = .805; I = 70.5%). Compared with general anesthesia, spinal anesthesia was a significant reduction in the occurrence of nausea (RR = 3.04, 95% CI 1.69-5.50, P = .000; I = 0.0%) and the length of hospital stay (WMD = 1.00, 95% CI 0.59-1.41, P = .000; I = 94.7%). CONCLUSION Spinal anesthesia was superior than general anesthesia in terms of the occurrence of nausea and shorten the length of hospital stay. The quality and number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of spinal anesthesia on reducing the blood loss after THA.
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