RESUMO
BACKGROUND: Spinal anesthesia is an effective modality for lumbar surgery. Patient eligibility with respect to medical comorbidities remains a topic of debate. Obesity (body mass index ≥30 kg/m2), anxiety, obstructive sleep apnea, reoperation at the same level, and multilevel operations have variously been reported as relative contraindications. We hypothesize that patients undergoing common lumbar surgeries with these comorbidities do not experience greater rates of complications compared with controls. METHODS: We analyzed a prospectively collected database of patients undergoing thoracolumbar surgery under spinal anesthesia and identified 422 cases. Surgeries were less than 3 hours (the duration of action of intrathecal bupivacaine) and include microdiscectomies, laminectomies, and both single-level and multilevel fusions. Procedures were performed by a single surgeon at a single academic center. In overlapping groups, 149 patients had a body mass index ≥30 kg/m2, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a previous operation at the same level. The control group included 132 patients who did not have these risk factors. Differences in important perioperative outcomes were assessed. RESULTS: There were no statistically significant differences in intraoperative and postoperative complications except 2 cases of pneumonia in the anxiety group and 1 case in the reoperative group. There were also no significant differences for patients with multiple risk factors. Rates of spinal fusion were similar among groups, although mean length of stay and operative time were different. CONCLUSIONS: Spinal anesthesia is a safe option for patients with significant comorbidities and can be considered for most patients undergoing routine lumbar surgeries.
RESUMO
BACKGROUND: Postoperative pain is a barrier to early mobility and discharge after lumbar surgery. Liposomal bupivacaine (LB) has been shown to decrease postoperative pain and narcotic consumption after transforaminal lumbar interbody fusions (TLIFs) when injected into the marginal suprafascial/subfascial plane-liposomal bupivacaine (MSSP-LB). Erector spinae plane (ESP) infiltration is a relatively new analgesic technique that may offer additional benefits when performed in addition to MSSP-LB. OBJECTIVE: To evaluate postoperative outcomes of combining ESP-LB with MSSP-LB compared with MSSP-LB alone after single-level TLIF. METHODS: A retrospective analysis was performed for patients undergoing single-level TLIFs under spinal anesthesia, 25 receiving combined ESP-LB and MSSP-LB and 25 receiving MSSP-LB alone. The primary outcome was length of hospitalization. Secondary outcomes included postoperative pain score, time to ambulation, and narcotics usage. RESULTS: Baseline demographics and length of surgery were similar between groups. Hospitalization was significantly decreased in the ESP-LB + MSSP-LB cohort (2.56 days vs 3.36 days, P = .007), as were days to ambulation (0.96 days vs 1.29 days, P = .026). Postoperative pain area under the curve was significantly decreased for ESP-LB + MSSP-LB at 12 to 24 hours (39.37 ± 21.02 vs 53.38 ± 22.11, P = .03) and total (44.46 ± 19.89 vs 50.51 ± 22.15, P = .025). Postoperative narcotic use was significantly less in the ESP-LB + MSSP-LB group at 12 to 24 hours (13.18 ± 4.65 vs 14.78 ± 4.44, P = .03) and for total hospitalization (137.3 ± 96.3 vs 194.7 ± 110.2, P = .04). CONCLUSION: Combining ESP-LB with MSSP-LB is superior to MSSP-LB alone for single-level TLIFs in decreasing length of hospital stay, time to ambulation, postoperative pain, and narcotic use.
