• David A W Sykes, Troy Q Tabarestani, Nauman S Chaudhry, David S Salven, Christopher I Shaffrey, W Michael Bullock, Nicole R Guinn, Jeffrey Gadsden, Miles Berger, and Muhammad M Abd-El-Barr.
• Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: david.sykes@duke.edu.
• World Neurosurg. 2023 Aug 1; 176: e91e100e91-e100.

ObjectiveThere is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal fusion procedures on length of stay (LOS), opioid use, time to ambulation (TTA), and procedure duration.MethodsThe authors performed a retrospective review of a single surgeon's patients who underwent lumbar fusions under SA versus GA from June of 2020 to June of 2022. SA patients were compared to demographically matched GA counterparts undergoing comparable procedures. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents, TTA, and LOS.ResultsTen SA patients were matched to 10 GA counterparts. The cohort had a mean age of 66.77, a mean body mass index of 27.73 kg/m2, and a median American Society of Anesthesiologists Physical Status Score of 3.00. LOS was lower in SA versus GA patients (12.87 vs. 50.79 hours, P = 0.001). Opioid utilization was reduced in SA versus GA patients (10.76 vs. 31.43 morphine milligram equivalents, P = 0.006). TTA was reduced in SA versus GA patients (7.22 vs. 29.87 hours, P = 0.022). Procedure duration was not significantly reduced in SA patients compared to GA patients (139.3 vs. 188.2 minutes, P = 0.089).ConclusionsThese preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with reduced hospital LOS, reduced opioid utilization, and reduced TTA. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.Copyright © 2023 Elsevier Inc. All rights reserved.

20 keywords...

hide…