Lumbar microdiscectomy under spinal and general anesthesia: a comparative study (original) (raw)
Related papers
Spinal or General anaesthesia for lumbar spine microdiscectomy Surgery…does it matter?
The Internet journal of spine surgery, 2007
Background : Prospective randomised study comparing immediate postoperative pain and satisfaction levels in patients having spinal versus general anaesthesia for single level lumbar microdiscectomy. Methods: Fifty consecutive patients were recruited and prospectively randomised into two equal groups, with half the patients receiving a spinal anaesthetic and the remainder a general anaesthetic. A comprehensive postoperative evaluation was carried out documenting any anaesthetic complication, pace of physiological and functional recovery and patient satisfaction. Results : Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. However the requirement for urinary catheterisation in this group was significantly higher. Conclusion: Despite better postoperative pain and functional outcomes for the spinal anaesthetic group and reported higher level of satisfaction when compared with general anaesthesia, the higher level of urinary retention in this group makes it impossible to perform this surgery as a day case procedure.
Epidural anesthesia in elective lumbar microdiscectomy surgery: is it safe and effective?
Turkish Neurosurgery, 2014
AIm: The aim of this study was to evaluate effectiveness and safety of epidural anesthesia in elective lumbar microdiscectomy surgery. mATErIAl and mEThOds: Twenty-seven patients (78%, female), who were admitted for single level simple microdiscectomy surgery between May 2012 and December 2013 in single spine center of a university hospital, were enrolled into the study. Clinical evaluations with demographical and per-operative data were collected prospectively. rEsulTs: Mean age was 60.04 years. Mean weight, height, and BMI of the study population were 77.7 kg, 160.22 cm, 30.26; respectively. Mean operation duration was 45.56 minutes. Mean VAS score for pain was 0.78 at immediate post-op, 0.52 at 4th hour, and 0.35 at post-operative 24 th hour. Ramsay sedation scale (RSS) scores steadily decreased from 2.07 in the immediate post-operative time to 1.93 at 4 th hour and 1.88 at 24 th hour. The only correlation seen between patient demographics and RSS was body weight seen in immediate post-operative period. Improvements for VAS scores for pain at 4 th and 24 th hours were 28% and 31%; respectively. Three patients had nausea, one of them vomited after the surgery. All patients were satisfied and would consider epidural anesthesia in future similar surgeries. CONClusION: Epidural anesthesia provides a safe and effective method for elective lumbar microdiscectomy surgery.
Lumbar microdiscectomy under epidural anesthesia: a comparison study
The Spine Journal, 2006
Lumbar microdiscectomy is most commonly performed under general anesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under epidural anesthesia. To investigate the safety and efficacy of epidural anesthesia in elective lumbar microdiscectomies. A prospective study evaluating the relative morbidities associated with epidural anesthesia and general anesthesia for lumbar microdiscectomy. Forty-three patients scheduled for primary lumbar microdiscectomy. Two cohorts were formed and were studied separately; one observational of all the 43 patients, and a second cohort of 17 patients who agreed to enter in the randomized trial. The clinical outcome was determined by the presence of postoperative pain, the absence of anesthesia-related complications, and the overall postoperative recovery. This was a prospective study. With institutional review board approval, 43 consecutive patients were enrolled in the study. However, only 17 patients agreed to be randomized to receive either general or epidural anesthesia for the procedure; the remaining 26 patients selected the type of anesthesia of their preference. Recorded data for all patients included: age; total surgical time; occurrence of nausea, vomiting, atelectasis, or cardiopulmonary complication; ability to arise out of bed on the day of surgery; and the total number of inpatient hospital days. Postoperative pain and satisfaction were assessed only in the randomized cohort. There were a total of 43 patients, with a mean age of 38.1 years. The patients undergoing epidural anesthesia were marginally older than those undergoing general anesthesia. The epidural and general anesthetic groups were not different with respect to surgical time, pain assessed with a linear visual analogue scale, hospital stay, or the likelihood of arising out of bed on the day of surgery. There were no major cardiopulmonary complications in either group. Patients with epidural anesthesia had significantly less nausea and vomiting. Epidural anesthesia as an alternative to general anesthesia has shown less postoperative nausea and vomiting in lumbar microdiscectomy. Nevertheless, given the small number of patients, this study should be considered as preliminary, showing small differences in minor potential complications.
Lumbar Microdiscectomy With Spinal Anesthesia
Spine, 2010
A 45 years old male, weighing 70 kg suffering from prolapsed intervertebral discs (PIVD) and was scheduled for decompression surgery at L3-L4, L4-L5 spinal levels. Spinal anesthesia was administered at L3-L4 interspace in the sitting position using 25gauge spinal needle and 3 ml of 0.5% hyperbaric bupivacaine was injected. The patient was turned prone after 5 min. After about two hours of surgery the patient complained of pain. A decision to administer spinal anesthesia again was undertaken as the dura mater was already exposed at the surgical site. Hyperbaric bupivacaine 1.5 ml was injected in the subarachnoid space under direct vision using 25G spinal needle. Adequate block was achieved and surgery was completed without. This report shows that intraoperative local anesthetic injections into the subarachnoid space under direct vision can be used to prolong the duration of the block.
Surgical Neurology, 2009
General anesthesia and regional anesthesia have both been shown to be suitable techniques for patients undergoing lower thoracic and lumbar spine surgery; however, GA is the most frequently used method. The purpose of this study was to conduct an acceptable RCT to compare the intraoperative parameters and postoperative outcome after SA and GA in patients undergoing elective lumbar disk surgery.Patients undergoing laminectomy for herniated lumbar disk during the years 2005 and 2007 were enrolled. They were randomly selected to undergo GA and SA. The variables recorded during the operation were the patients' HR, MAP, amount of blood loss, and surgeons' satisfaction with the operating conditions. The severity of pain, nausea, vomiting, and length of stay in the hospital were recorded in the postoperative course.The mean blood loss was less in the group undergoing GA; however, the difference was not statistically significant. The surgeon's satisfaction was reported to be higher in the GA group. No major intraoperative complication was reported in either series. During the recovery period, hypertension was reported to happen more frequently in the patients undergoing GA; and postoperative nausea and vomiting were more frequent among patients recovering from SA.Contrary to previous studies, the findings of the present study revealed that SA has no advantages over GA. Moreover, it was showed that GA can reduce the related risks and complications in several aspects.
Chapter 1 Spinal Anaesthesia in Spinal Surgery
2014
Surgery for lumbar disc prolapse is one of the most common spinal procedures. Lumbar microdiscectomy is usually performed under general anaesthesia despite recent publications showed that these procedures can be performed safely also under spinal anaesthesia. Indeed, some authors have previously highlighted the possibility of using spinal anaesthesia for decompressive laminectomy and microdiscectomy, so avoiding the risks related to the general anaesthesia and allowing to reduce the length of the inpatient stay and the overall costs. In this chapter we will also expose different surgical procedures performed with local and general anaesthesia as well and we will give the possibility to the reader to realize the mean important differences with the use of the spinal anaesthesia.
Journal of Clinical Neuroscience, 2010
In a prospective study we compared the surgical outcome, length of hospital stay, complications and patient satisfaction for patients undergoing lumbar microdiscectomy (LM) under spinal anaesthesia (SA) in the sitting position (23 patients) to those of another cohort who underwent LM under general anaesthesia (GA) in the prone or genu-pectoral position during the same time period (238 patients). We aimed to determine: (i) if epidural anaesthesia is safe for lumbar microdiscectomy; and (ii) if placing the patient in a sitting position confers an advantage in performing the operation. For all patients we calculated the time from the end of the operation to the first spontaneous urination and to the first administration of analgesic drugs. Before being discharged, patients were asked to give an opinion on the quality of analgesia obtained by epidural anaesthesia and on the sitting position used. No patient had any complications linked to epidural anaesthesia and only one patient experienced a small dural tear as a surgical complication. Twenty of 23 patients expressed satisfaction with the level of analgesia obtained and only three considered it poor. All patients found the sitting position comfortable. Advantages of the sitting position for surgery include better comfort for the patient, potential to recreate a load condition similar to the one that takes place during orthostasis and a ''cleaner" operative field that uses gravity to drain blood. Of greatest concern is the possibility of the patient developing a dural tear and subsequent leaking of cerebrospinal fluid, which could also be a source of surgical complications. Currently, epidural anaesthesia allows a reduction in anaesthetic and surgical times, anaesthetic complications and, consequently, hospitalization period. Further analysis of the sitting position for the patient during surgery is required to fully assess the advantages and disadvantages of this method.
Clinical Spine Surgery: A Spine Publication, 2018
This study aims to characterize the effect of preoperative symptom duration on postoperative outcomes after minimally invasive lumbar microdiscectomy (MIS LD). Summary of Background Data: It is unknown whether extended nonoperative treatment before MIS LD has implications for long-term clinical outcomes even after surgery is performed. Materials and Methods: A prospectively maintained surgical registry of patients undergoing MIS LD by a single surgeon between 2013 and 2017 was reviewed. Preoperative symptom duration was dichotomized into 2 groups (≤ 6 and > 6 mo). Only patients with full clinical data at 6 months postoperative followup were included in the study. Clinical outcomes were assessed at 6, 12 weeks, and 6 months after surgery. The number of patients obtaining a minimum clinically important difference was assessed. Groups were compared with the χ 2 analysis and the student t tests for categorical and continuous data, respectively. Results: In total, 94 patients were identified. A total of 45 patients (47.9%) had symptom duration ≤ 6 months. No differences in baseline characteristics were found (P > 0.05). Patients with shorter symptom duration had significantly greater improvement in Oswestry Disability Index scores at 6 weeks (P = 0.004), 12 weeks (P = 0.022), and 6 months (P = 0.005). Patients with shorter duration of symptoms also obtained minimum clinically important difference for Oswestry Disability Index at a greater rate than those with longer duration of symptoms (P = 0.015). Conclusions: Although patients who underwent MIS LD within 6 months of symptom onset had similar baseline characteristics compared with patients who underwent surgery after 6 months of symptoms, the patients with longer preoperative symptom duration had worse functional outcomes at 6 months after surgery. These results suggest that earlier MIS lumbar microdiscectomy may provide a functional benefit for patients. Further studies should therefore evaluate the efficacy of nonoperative treatment in the setting of lumbar herniated nucleus pulposus, as prolonged conservative management may potentially impair functional recovery after surgery.
2014
Background and aim: General anesthesia (GA) is the most commonly used anesthetic technique for spinal surgery. This study aimed to compare spinal anesthesia (SA) and GA in patients undergoing spinal surgery, in terms of perioperative outcome and cost effectiveness. Materials and methods: The study included 80 patients with ASA (American Society of Anesthesiologists) physical status I-II. The patients were randomized to receive SA (n = 40) or GA (n = 40). Heart rate (HR), mean arterial blood pressure (MABP), blood loss, duration of surgery, duration of anesthesia, surgeon satisfaction, and duration in the post-anesthesia care unit (PACU) were recorded. Postoperative analgesic requirement, nausea and vomiting (PONV), perioperative hemodynamic variables, and anesthetic costs were determined. Results: HR and MABP were significantly higher in the GA group than in the SA group at the end of surgery and at PACU admission. Duration of anesthesia, surgeon satisfaction, postoperative analgesic requirement, and anesthetic costs were significantly higher in the GA group. Mean blood loss was lower in the SA group than in the GA group, but the difference was not significant. Duration of surgery, duration in the PACU, perioperative hemodynamic variables, and complications were similar in both groups. Conclusions: SA could be considered a reliable alternative to GA in patients undergoing lumber spine surgery, as it is clinically as effective as GA, but more cost effective.
Audit of Lumbar Spine Operations Performed Under Spinal Anaesthesia
Medical & Clinical Reviews, 2016
Introduction: Spinal and epidural anaesthesia was performed in selected patients undergoing lumbar spine surgery in a private clinic. The technique will be described in detail and the results reported. Materials and methods: This study reports on patients admitted and operated upon from 1 st May 2014 till 31 st August 2015. We performed a retrospective review of all the patients operated in the hospital during the period and selected out those who had regional anaesthesia for audit. This study reports on patients admitted and operated between 1 st May 2014 and 31 st August 2015. The patients were managed at Spine Fixed in Abuja, a private clinic in Abuja, Nigeria. We performed a retrospective review of all the patients operated in the clinic during the period and selected out those who had regional anaesthesia for audit. The case notes were collected and reviewed. The demographics, operation details and short term outcome at the final clinic visit were entered into a database. The medium term outcome as related to need for another operation was determined from telephone calls to the patients made in March 2016. Results: Twenty eight out of 32 patients had simple lumbar spinal operations performed under spinal anaesthesia in the period under review. There were 12 males and 16 females with age range 24-77 years. Sixteen out of the 28 patients had one level lumbar spine decompression, while the remaining 12 had two-level spinal decompression performed. None of the patients required blood transfusion, and none of the patients had anaesthetic or surgical complications peri-operatively. There were no complications such as dural tears, nerve injuries related to the procedures though one patient vomited in the recovery room. The post-operative analgesia was maintained for over 4 hours post operatively. On review in March 2016, the patients and the surgeon were satisfied with spinal anaesthesia in all cases. Conclusion: Lumbar surgery can be performed safely under regional anaesthesia. For patients undergoing decompressive lumbar spine surgery, regional anaesthesia is an effective technique with potential advantages. In our experience, the operations were well tolerated by patients with good recovery and minimal complications. The short term outcome was also satisfactory.