Spinal anaesthesia safe for high-risk lumbar spinal surgery patients

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Spinal anaesthesia

Spinal anaesthesia is safe for high-risk patients undergoing lumbar spinal surgery, and allows for better perioperative hemodynamic stability compared to general anesthesia, a recent study published in the Journal of Clinical Anesthesia reports.

The study, by Michael Finsterwald (Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland) and colleagues, also found that lumbar spine surgery with spinal anesthesia in cardiovascular high-risk patients might lead to lower health costs.

The authors carried out a retrospective analysis of 146 patients who underwent lumbar spine surgery under spinal anaesthetic, compared with 292 patients who were operated under general anaesthetic between 2000 and 2014. The investigators assessed hemodynamic effects, hospitalisation times, complications and costs according to the Swiss billing system.

Spinal anaesthesia was associated with significantly better perioperative haemodynamic stability with less need for intraoperative vasopressors (15% vs. 57%, p<0.001), volume supplementation (1113 ml±458 vs. 1589±644, p<0.001) and transfusions (0% vs. 4%, p<0.001). Additionally, the number of hypotension episodes was lower in the spinal anesthesia group (15% vs. 47%, p<0.001).

Furthermore, the spinal anaesthesia group showed a significantly shorter duration of surgery, at 70 minutes versus 91 minutes in the general anesthetic group (p<0.001). Postoperatively, nausea and vomiting is also lower in the spinal anaesthesia group, experienced by only 4% of patients, as opposed to 28% in the general anesthetic group (p<0.001). Pain in the post-anaesthesia care unit, as measured on the visual analogue scale, was also lower in the spinal anaesthetic group than the general anaesthetic one, although pain after 24 hours did not differ.

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