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A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery: A Meta-Analysis of Randomized Studies

Zorrilla-Vaca, Andres BSc*,†; Healy, Ryan J. BSc*; Mirski, Marek A. MD, PhD*

Journal of Neurosurgical Anesthesiology: October 2017 - Volume 29 - Issue 4 - p 415–425
doi: 10.1097/ANA.0000000000000362
Clinical Investigations
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Background: General anesthesia (GA) is commonly used for lumbar spine surgery. The advantages of regional anesthesia (RA) for lumbar spine surgery, as compared with GA, remain unclear. The aim of this meta-analysis was to determine the impact of the type of anesthesia on intraoperative events, incidence of postoperative complications, and recovery time of patients undergoing lumbar spine surgery.

Methods: Major databases (PubMed, EMBASE, Cochrane library, ISI Web of Science, and Google Scholar) were systematically searched for randomized clinical trials comparing regional versus GA for lumbar spine surgery. Study-level characteristics, intraoperative events, and postoperative complications were extracted from the articles. Meta-analysis was performed using random-effect models.

Results: Fifteen randomized clinical trials comprising 961 patients were included in this meta-analysis. The use of RA for lumbar spine surgery was significantly associated with lower incidence of postoperative nausea and vomiting at 24 hours (risk ratio [RR]=0.42; 95% confidence interval [CI]=0.23-0.77, P=0.005), as well as lower length of stay (standardized mean difference [SMD]=−0.73; 95% CI=−1.17 to −0.29, P=0.001) and intraoperative blood loss (SMD=−1.24; 95% CI=−2.27 to −0.21, P=0.02). There was no statistically significant association with lower pain score (SMD=−0.47; 95% CI=−2.13 to 1.19, P=0.58), lower incidence of urinary retention (RR=1.16; 95% CI=0.73-1.86, P=0.53) or analgesic requirement (RR=0.87; 95% CI=0.64-1.18, P=0.37).

Conclusions: In summary, RA has several advantageous characteristics, including lower incidence of postoperative nausea and vomiting, length of stay, and blood loss. Further well-designed studies with more sample size are needed to clarify the associations with possible neurological complications.

Supplemental Digital Content is available in the text.

*Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD

School of Medicine, Faculty of Health, Universidad del Valle, Hospital University of Valle, Cali, Colombia

A.Z.-V. receives research support by the Colombian Society of Anesthesiology and Reanimation. The remaining authors have no funding or conflicts of interest to disclose.

Address correspondence to: Andres Zorrilla-Vaca, School of Medicine, Faculty of Health, Universidad del Valle, Cra 5B # 36-00 Cali, 760026 Colombia (e-mail: andres.zorrilla@correounivalle.edu.co; azorrilla1@jhmi.edu).

Received March 29, 2016

Accepted July 18, 2016

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