Microdiscectomy: spinal anesthesia offers optimal results in general patient population.
Spinal anesthesia provides a safe and highly satisfactory alternative to general anesthesia in patients undergoing limited lumbar surgery. Nevertheless, it is not commonly used for spinal surgery, and in some centers it is not even considered as an option for spinal procedures. This study presents the current anesthetic technique for patients undergoing microdiscectomy and compares the peri- and postoperative outcomes in 76 patients drawn from a case-controlled study group. Patients underwent microdiscectomy for herniated nucleus pulposus under spinal (43 patients) or general anesthesia (33 patients). Patients ranged from 18 to 40 years, and all were anesthesia class 1. Surgical and anesthesia times were longer for the general anesthetic group, as was total anesthetic time. Urinary retention was more common in the general anesthesia group (p = .035). Postanesthetic care unit admission times were significantly shorter among general anesthetic patients compared with spinal anesthetic patients (p < .001). Spinal anesthesia patients required less pain medication and experienced less nausea and emesis. Even among young, medically fit patients, spinal anesthesia provided specific advantages over general anesthesia, including decreased anesthesia time, decreased nausea and antiemetic requirements, reduced analgesic requirements, and a trend toward lower complication rates and shorter hospital stay. Both surgeon and patient satisfaction with this anesthetic approach is high.
McLain
Robert F
RF
The Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. mclainr@ccf.org
Tetzlaff
John E
JE
Bell
Gordon R
GR
Uwe-Lewandrowski
Kai
K
Yoon
Helen J
HJ
Rana
Maunak
M
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General / Q000592:standards; D000775:Anesthesia, Spinal / Q000592:standards*; D016022:Case-Control Studies; D017586:Diskectomy / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D013997:Time Factors; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D000700:Analgesics