Abstract
Introduction
Spine surgery like discectomy, decompression and lumbar fusions are most commonly performed under general anesthesia, which can be associated with several perioperative morbidities including prone positioning morbidities (for example ocular complications especially in patients with single precious eye), nausea, vomiting, lung atelectasis, pulmonary aspiration, prolonged post-anesthesia recovery and special complications for high risk patients as those with chest problems and or liver problems. It may be possible to reduce general anesthesia complications rate if the procedure is performed under spinal anesthesia. This may also remarkably reduce postoperative pain.
Material and Methods
To investigate the safety and efficacy of spinal anesthesia in elective lumbar spine surgeries. A prospective study evaluating the relative morbidities associated with Spinal anesthesia for lumbar and lower dorsal spine surgery. 174 patients scheduled for spine surgery. 172 patients scheduled for lumbar surgery(revision posterior spinal fusion 11 patients, removal of instrumentation 5 patients, vertebroplasty 25 patients, 15 patients for soft TLIF, 23 patients for Posterolateral fusion, 26 for TLIF, 37 for decompression and 30 patients for discectomies). Two patients scheduled for dorsal 10–11–12 decompression and posterolateral fusion. The clinical outcome was determined by the presence of postoperative pain, the absence of anesthesia-related complications, and the overall postoperative recovery.patients satisfaction was evaluated by asking questions about their experience. 174 patients agreed to receive spinal anesthesia for the procedure. 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 Formularbeginn.
Results
There were a total of 174 patients, with a mean age range from (16–75 years). The patients undergoing spine surgery with spinal anesthesia.operative time range from (45–300 minutes) The spinal anesthesia were different with respect to the expected 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. Patients with spinal anesthesia had no nausea and vomiting.spinal anaesia produce hypotension and decrease blood loss. These patients were able to help us at positioning at the beginning of surgery. Intraoperative talks or interactions was possible. Blood loss range(50cc-1200cc) We need to inject extra dose during surgery in 7 cases and only one 3 level revision lumbar case last for 5 hours we need to convert after 3 hours to general anesthesia. Postoperative patient can eat immediately. Delayed assessment of the full neural recovery is the only drawback.
Conclusions Lumbar spine anesthesia as an alternative to general anesthesia in spine surgery has shown less blood loss, better surgical field better postoperative pain control, less postoperative nausea and vomiting and less positioning complications.