Spinal Anesthesia for Lumbar Spine Surgery


Reg Anesth 1995 Nov;20(6):533-537

Influence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spine surgery.

Tetzlaff JE, O'Hara J, Bell G, Grimm K, Yoon HJ

Department of General Anesthesiology, Cleveland Clinic Foundation, Ohio 44195, USA.

BACKGROUND AND OBJECTIVES: Although the majority of elective lumbar spine surgical procedures are performed under general anesthesia, successful use of spinal and epidural anesthesia has been reported. This study was designed to evaluate the influence of baricity on the performance of spinal anesthesia for lumbar spine surgery. METHODS: The study was performed on 53 demographically similar American Society of Anesthesiologists status 1 and 2 patients who were randomly assigned to receive spinal anesthesia with 15 mg of bupivacaine along with 0.2 mg of epinephrine as either 3 ml 0.5% plain bupivacaine (I group) or 2 ml 0.75% bupivacaine (Sensorcaine Spinal, Astra, Westborough, MA) premixed in 8.25% glucose (H group). All blocks were placed with a 22-gauge Quincke needle (Becton Dickinson, Franklin Lakes, NJ) at the L3-L4 interspace with the patient in the sitting position. Subsequent data, collected by a blinded observer, included onset of motor and sensory anesthesia, highest sensory level achieved, maximum changes in heart rate and blood pressure, need for treatment of heart rate or blood pressure decreases, failed blocks, and need for supplemental local anesthetic injection to complete incision or wound closure. RESULTS: The time to onset for complete motor and sensory block was significantly longer in the I group. The maximum sensory level achieved was higher in the H group, and the maximum drop in blood pressure and number of interventions to treat heart rate and blood pressure were greater in the H group. There were two failed blocks, which were repeated successfully, in the H group. The need for local anesthetic infiltration of the wound with incision and closure was greater in the H group. CONCLUSIONS: Plain bupivacaine is superior to hyperbaric bupivacaine for spinal anesthesia for elective lumbar spine surgery.



Anesth Analg 1996 Sep;83(3):559-564

A prospective randomized study comparing short- and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery.

Jellish WS, Thalji Z, Stevenson K, Shea J

Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.

General or regional anesthesia may be used for lumbar laminectomy. To determine whether one method is superior, 122 patients were randomly assigned to receive either a standard general anesthetic (GA) or spinal anesthesia (SA) supplemented with intravenous (IV) propofol sedation. Data from the intraoperative period through hospital discharge were collected and compared. Demographically, both groups were similar. Total anesthesia (131.0 +/- 4.3 vs 106.6 +/- 3.2 min) and surgical times (81.5 +/- 3.6 vs 67.1 +/- 2.8 min) were longer in the GA group. Intraoperative hemodynamics were similar between groups except that the incidence of increased blood pressure was more frequent with GA (26.2% vs 3.3%). Blood loss was less during SA (133 +/- 18 mL vs 221 +/- 32 mL). Postanesthesia care unit (PACU) heart rates and mean arterial pressures were higher in the GA group. Peak pain scores in the PACU were higher after GA compared with SA (58 +/- 4 vs 22 +/- 3) as were the number of patients who required analgesics. Severe nausea was more common in the GA group both in the PACU and during the 24 h after surgery. Analgesic requirements after discharge from the PACU, urinary retention, and days in the hospital did not differ between groups. This study suggests that SA may be superior to GA both intraoperatively and postoperatively for lumbar spine procedures lasting less than 2 h.