GENERAL ANAESTHESIA VERSUS REGIONAL ANAESTHESIA FOR LUMBAR LAMINECTOMY: A REVIEW OF THE MODERN LITERATURE
AbstractBackground: Lumbar spine surgery can be performed using different anaesthetic techniques such as general endotracheal anaesthesia (GA) or spinal-based regional anaesthesia (RA). Few of the studies have been done to compare the outcomes of spinal anaesthesia versus general anaesthesia for lumbar laminectomies as both having some advantages as well as disadvantages but still it is controversial. The objective of current study is to make a comprehensive review of literature for comparing the outcomes of lumbar laminectomy performed under general anaesthesia versus spinal anaesthesia. Method: Literature search was performed by using PubMed, Google scholar and bibliography of related articles. To compare groups of general anaesthesia versus spinal anaesthesia, the variables focused were mean heart rate (HR), mean arterial pressure (MAP), blood loss during surgery, duration of surgery, post-operative anaesthesia care unit (PACU) time, post-operative narcotic use/pain scale, post-operative urinary retention, and post-operative nausea/vomiting. Results: Data of eleven studies were presented in current article, of these five were randomized controlled trials, three case-controls and four were retrospective cohort studies. 5/8 studies reported that SA group having more hemodynamic stability with postoperative outcomes as compared to GA. Likewise, majority of reviewed studies (7/8) reported better pain control or decreased requirement of analgesics in SA group. Additionally, more than half of the reviewed studies (5/8) reported lower incidence of postoperative nausea and vomiting among patients of SA group. Conclusion: The current study concluded that SA has better outcomes than GA in terms of hemodynamic stability and decrease postoperative adverse effects. So special attention should be paid for SA as an alternative to GA for lumbar laminectomy.Keywords: Spinal Anaesthesia; General Anaesthesia; Lumbar; Laminectomy
Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anaesthesia versus general anaesthesia for elective lumbar spine surgery: A randomized clinical trial. J Res Med Sci 2011;16(4):524–9.
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321(7275):1493.
Scott N, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg 1988;75(4):299–304.
Modig J, Karlström G. Intra-and post-operative blood loss and haemodynamics in total hip replacement when performed under lumbar epidural versus general anaesthesia. Eur J Anaesthesiol 1987;4(5):345–55.
Sztark F, Le Goff M, André D, Ritchie K, Dartigues J, Helmer C. Exposure to general anaesthesia could increase the risk of dementia in elderly: 18AP1-4. Eur J Anaesthesiol (EJA) 2013;30:245.
Cucchiara RF, Black S, Michenfelder JD, editors. Clinical neuroanaesthesia: Churchill Livingstone; 1998.
Abrishamkar S, Aminmansour B, Arti H. The effectiveness of computed tomography scans versus magnetic resonance imaging for decision making in patients with low back pain and radicular leg pain. J Res Med Sci 2006;11(6):351–4.
Sadrolsadat SH, Mahdavi AR, Moharari RS, Khajavi MR, Khashayar P, Najafi A, et al. A prospective randomized trial comparing the technique of spinal and general anaesthesia for lumbar disk surgery: a study of 100 cases. Surg Neurol 2009;71(1):60–5.
McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anaesthesia. Spine 2004;29(22):2542–7.
McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M. Comparison of spinal and general anaesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2005;2(1):17–22.
Greenbarg PE, Brown MD, Pallares VS, Tompkins JS, Mann NH. Epidural anaesthesia for lumbar spine surgery. J Spinal Disord 1988;1(2):139–43.
Jellish WS, Thalji Z, Stevenson K, Shea J. A prospective randomized study comparing short-and intermediate-term perioperative outcome variables after spinal or general anaesthesia for lumbar disk and laminectomy surgery. Anesth Anal 1996;83(3):559–64.
Rung GW, Williams D, Gelb DE, Grubb M. Isobaric spinal anaesthesia for lumbar disk surgery. Anesth Anal 1997;84(5):1165–6.
Tetzlaff JE, Dilger JA, Kodsy M, Al-Bataineh J, Yoon HJ, Bell GR. Spinal anaesthesia for elective lumbar spine surgery. J Clin Anesth 1998;10(8):666–9.
Khajavi MR, Asadian MA, Imani F, Etezadi F, Moharari RS, Amirjamshidi A. General anaesthesia versus combined epidural/general anaesthesia for elective lumbar spine disc surgery: A randomized clinical trial comparing the impact of the two methods upon the outcome variables. Surg Neurol Int 2013;4:105.
Kahveci K, Doger C, Ornek D, Gokcinar D, Aydemir S, Ozay R. Perioperative outcome and cost-effectiveness of spinal versus general anaesthesia for lumbar spine surgery. Neurol Neurochir pol 2014;48(3):167–73.
Agarwal P, Pierce J, Welch WC. Cost analysis of spinal versus general anaesthesia for lumbar diskectomy and laminectomy spine surgery. World Neurosurg 2016;89:266–71.
Pierce JT, Kositratna G, Attiah MA, Kallan MJ, Koenigsberg R, Syre P, et al. Efficiency of spinal anaesthesia versus general anaesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients. Local Reg Anesth 2017;10:91.
Chen HT, Tsai CH, Chao SC, Kao TH, Chen YJ, Hsu HC, et al. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anaesthesia. Surg Neurol Int 2011;2:93.
Limongi JAG, Lins de Melo RSA. Cardiopulmonary arrest in spinal anaesthesia. Rev Bras Anestesiol 2011;61(1):115–20.
Hebl JR, Horlocker TT, Kopp SL, Schroeder DR. Neuraxial blockade in patients with preexisting spinal stenosis, lumbar disk disease, or prior spine surgery: efficacy and neurologic complications. Anesth Anal 2010;111(6):1511–9.
Kehlet H. The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Chir Scand Suppl 1989;550:22–8.
Covino BG. Rationale for spinal anaesthesia. Int Anesth Clin 1989;27(1):8–12.
McLain RF, Tetzlaff JE, Bell GR, Uwe-Lewandrowski K, Yoon HJ, Rana M. Microdiscectomy: spinal anaesthesia offers optimal results in general patient population. J Surg Orthop Adv 2007;16(1):5–11.