Anesthetic Considerations in Spine Surgery: What Orthopaedic Surgeon Should Know!

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2020 Sep 4

PMID 32879562

Citations 5

Authors

Puneet Khanna

Soumya Sarkar

Bhavuk Garg

Affiliations

Soon will be listed here.

Abstract

With clinical innovation and technological advancement, the paradigm of surgical procedures on the spine and spinal cord along with the perioperative management are rapidly evolving. Irrespective of different modes the anesthetic management of spine surgery is challenging in view of significant blood loss, prolong procedure, position-related complications, and complex pain management. The enhanced recovery after surgery (ERAS) for this kind of surgery is yet to be finalized. The aim of this article is to highlight the current evidence-based major perioperative considerations for patients undergoing spine surgery.

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References

Basques B, Anandasivam N, Webb M, Samuel A, Lukasiewicz A, Bohl D . Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion. Spine (Phila Pa 1976). 2015; 40(22):1792-7. DOI: 10.1097/BRS.0000000000001047. View

. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2011; 116(1):15-24. DOI: 10.1097/ALN.0b013e31823d012a. View

Li G, Patel N, Hagemeister J, Yan J, Wu D, Sharma K . Body-mounted robotic assistant for MRI-guided low back pain injection. Int J Comput Assist Radiol Surg. 2019; 15(2):321-331. PMC: 7027988. DOI: 10.1007/s11548-019-02080-3. View

Aoude A, Nooh A, Fortin M, Aldebeyan S, Jarzem P, Ouellet J . Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database. Global Spine J. 2016; 6(8):756-764. PMC: 5110346. DOI: 10.1055/s-0036-1580736. View

Yuan L, Zeng Y, Chen Z, Zhang X, Mai S, Song P . Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis. Chin Med J (Engl). 2019; 132(5):577-588. PMC: 6416000. DOI: 10.1097/CM9.0000000000000108. View

Staub B, Sadrameli S . The use of robotics in minimally invasive spine surgery. J Spine Surg. 2019; 5(Suppl 1):S31-S40. PMC: 6626754. DOI: 10.21037/jss.2019.04.16. View

S D, Shetty A, Subramanian B, Kanna R, Rajasekaran S . A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery. Spine J. 2018; 19(4):569-577. DOI: 10.1016/j.spinee.2018.10.010. View

Pendi A, Acosta F, Tuchman A, Movahedi R, Sivasundaram L, Arif I . Intrathecal Morphine in Spine Surgery: A Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2017; 42(12):E740-E747. DOI: 10.1097/BRS.0000000000002198. View

Attari M, Mirhosseini S, Honarmand A, Safavi M . Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. J Res Med Sci. 2011; 16(4):524-9. PMC: 3214358. View

10.

Pradeep Kumar K, Kulkarni D, Gurajala I, Gopinath R . Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: a randomized, double-blinded, placebo-controlled study. J Pain Res. 2013; 6:471-8. PMC: 3699253. DOI: 10.2147/JPR.S43613. View

11.

Meng Y, Jiang H, Zhang C, Zhao J, Wang C, Gao R . A comparison of the postoperative analgesic efficacy between epidural and intravenous analgesia in major spine surgery: a meta-analysis. J Pain Res. 2017; 10:405-415. PMC: 5319425. DOI: 10.2147/JPR.S128523. View

12.

Zhang Z, Xu H, Zhang Y, Li W, Yang Y, Han T . Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials. J Clin Anesth. 2017; 43:84-89. DOI: 10.1016/j.jclinane.2017.08.030. View

13.

Deyo R, Mirza S, Martin B, Kreuter W, Goodman D, Jarvik J . Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010; 303(13):1259-65. PMC: 2885954. DOI: 10.1001/jama.2010.338. View

14.

. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the.... Anesthesiology. 2018; 130(1):12-30. PMC: 9556164. DOI: 10.1097/ALN.0000000000002503. View

15.

Murray D, Forbes R, Titone M, Weinstein S . Transfusion management in pediatric and adolescent scoliosis surgery. Efficacy of autologous blood. Spine (Phila Pa 1976). 1998; 22(23):2735-40. DOI: 10.1097/00007632-199712010-00007. View

16.

Shimia M, Parish M, Abedini N . The effect of intravenous paracetamol on postoperative pain after lumbar discectomy. Asian Spine J. 2014; 8(4):400-4. PMC: 4149981. DOI: 10.4184/asj.2014.8.4.400. View

17.

Wainwright T, Immins T, Middleton R . Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Pract Res Clin Anaesthesiol. 2016; 30(1):91-102. DOI: 10.1016/j.bpa.2015.11.001. View

18.

Soffin E, Wetmore D, Barber L, Vaishnav A, Beckman J, Albert T . An enhanced recovery after surgery pathway: association with rapid discharge and minimal complications after anterior cervical spine surgery. Neurosurg Focus. 2019; 46(4):E9. DOI: 10.3171/2019.1.FOCUS18643. View

19.

Shillingford J, Laratta J, Sarpong N, Swindell H, Cerpa M, Lehman R . Visual Loss Following Spine Surgery: What Have We Seen Within the Scoliosis Research Society Morbidity and Mortality Database?. Spine (Phila Pa 1976). 2018; 43(17):1201-1207. DOI: 10.1097/BRS.0000000000002592. View

20.

Mathiesen O, Dahl B, Thomsen B, Kitter B, Sonne N, Dahl J . A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J. 2013; 22(9):2089-96. PMC: 3777071. DOI: 10.1007/s00586-013-2826-1. View