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Lumbar spine surgeries under spinal anesthesia in high risk patients: A retrospective analysis

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AUTHORS: Patil H et al

World Neurosurgery (Jan 2019)

Lumbar surgery can be performed under general or regional anesthesia (epidural or spinal anesthesia). General anesthesia (GA) is commonly used technique. Associated comorbidities may make general anesthesia risky or contraindicated. Since last decade the available literature has increased progressively in support of regional anesthesia for lumbar spine surgery. However in high risk lumbar spine surgery benefits of spinal anesthesia are unclear. Herein authors presented their experience of spinal anesthesia (SA) in cases where general anesthesia is contraindicated.

MATERIALS AND METHODS This was a retrospective study conducted in Bansal hospital, Bhopal. The aim of this study was to determine the outcomes of SA in high risk patients who underwent lumbar spine surgery where GA was contraindicated. Spinal anesthesia was given with help of heavy bupivacaine in sitting position. After assessing sensory level, patients were placed into prone position. Throughout the surgery, hemodynamic parameters were monitored. At the end of surgery, patients were turned back into the supine position, taken out of theatre and monitored in the recovery room. Postoperatively post-anesthesia care unit (PACU) time, hemodynamic changes, incidence of nausea and vomiting, urinary retention, spinal headache, analgesic use, regression of sensory block, hospital stay were noted. Patients and surgeon’s satisfaction was also assessed.

RESULTS Total 18 high risk lumbar spine disease patients were included in our study. Out of 18 patients 12 patients were ASA grade IV and 6 were ASA grade III. 10 patients underwent microdiscectomy while 8 patients underwent canal and lateral recess decompression. None of the patients had anesthetic or surgical complications. Postoperative pain relief was excellent. There were no incidences of postoperative vomiting and urinary retention. Only 2 patients (11.11%) developed nausea. Both surgeon and patients had a high level of satisfaction. SA was 12 % cheaper than general anesthesia.

CONCLUSION Spinal anesthesia is a safe, reliable and satisfactory alternative to general anesthesia in high risk lumbar spine surgeries. Postoperative morbidity or mortality can be reduced by spinal anesthesia and analgesia techniques.SA allows good perioperative hemodynamic stability and also more cost effective.

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