Asian Spine J.  2023 Apr;17(2):285-292. 10.31616/asj.2022.0198.

A Novel Combined Anesthetic Technique to Improve the Surgical Working Conditions of Lumbar and Thoracolumbar Spine Surgery from a Spine Surgeon’s Perspective: A Prospective Randomized Controlled Study

• Subbiah M
• Madhuvarshinee KM
• Vinothan RJS
• Poornima V
• Ramanarayanan R
• Manikandan B
• Suresh P
• James VA
• Yegumuthu K

• KMID: 2541656
• DOI: http://doi.org/10.31616/asj.2022.0198

Abstract

Study Design: Prospective randomized controlled study. Purpose: This study aimed to assess the effects of a different combination of anesthetic techniques in lumbar and thoracolumbar spinal surgeries in terms of muscle relaxation and surgical field in addition to hemodynamic parameters. Overview of Literature: Adequate relaxation of the erector spinae muscle and good surgical fields are preferred in lumbar spine surgeries. The effects of anesthetic techniques on these parameters have not been evaluated from a surgeon’s perspective to date. We propose a novel combined anesthetic technique that improves the working conditions from a surgeon’s perspective as we hypothesize that combining general anesthesia (GA) with regional anesthesia (RA) might provide benefits for both techniques.
Methods
A prospective randomized study of 76 patients who underwent lumbar and thoracolumbar surgeries was conducted by randomly allocating patients into three anesthetic groups: GA alone, GA with spinal anesthesia (SA), and GA with erector spinae plane block (ESPB) by the allocation concealment method to avoid selection bias. The working conditions were assessed by the same operating surgeon who was blinded by the type of anesthesia to eliminate the assessment bias. Muscle relaxation and surgical field were compared among the three groups along with other hemodynamic parameters to identify any significant differences.
Results
Significantly better muscle relaxation, surgeon satisfaction, postoperative analgesia, and blood pressure (BP) were observed in the GA+RA when compared to GA alone (p <0.01), whereas no difference was observed between the GA+SA and GA+ESPB groups (p >0.05). Complications were only observed in the GA+SA group (19%).
Conclusions
The study results suggest that the addition of RA to GA may provide better working conditions and surgeon’s satisfaction by improving relaxation of the erector spinae in addition to decreasing the BP and postoperative pain in contrast to the use of GA alone. The combined GA and ESPB techniques may be a viable anesthetic alternative to provide better working conditions for surgeons.

Keyword

Lumbar vertebrae; Muscle relaxation; Nerve block; Paraspinal muscles; Spine