Introduction: Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique.
Methods: Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay.
Results: 544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., p < 0.001), total anesthesia time (145.6 vs. 217.5 min., p < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, p<0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., p<0.001), and length of hospital stay (1.5 vs. 3.1 days, p < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., p < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, p < 0.001).
Conclusions: Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.
Patient Care: This research aims to improve the efficiency of all phases of lumbar laminectomy and discectomy surgery while maintaining the safety and efficacy of the anesthetic modality
Learning Objectives: 1) Characterize the time required for all perioperative phases of lumbar laminectomy and discectomy surgery when comparing spinal and general anesthesia
2) Estimate the intraoperative estimated blood loss in lumbar spine surgery when comparing spinal and general anesthesia
3) Improve the efficiency of all phases of lumbar spine surgery while maintaining the safety and efficacy of the anesthetic modality