Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis,European Spine Journal

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Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis
European Spine Journal ( IF 2.6 ) Pub Date : 2023-12-19 , DOI: 10.1007/s00586-023-08071-y
Rami Rajjoub ₁ , Abdul Karim Ghaith ₁ , Victor Gabriel El-Hajj _{1,

2} , Jorge Rios-Zermano ₃ , Gaetano De Biase ₃ , Elias Atallah ₄ , Ali Tfaily ₅ , Hassan Saad ₅ , Oluwaseun O Akinduro ₃ , Adrian Elmi-Terander ₂ , Kingsley Abode-Iyamah _{3,

6}

Affiliation

Background

Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic.

Methods

A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models.

Results

In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): − 0.40 days; 95% CI − 0.64 to − 0.17) and operative time (MD: − 19.17 min; 95% CI − 29.68 to − 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47–0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39–0.90]) and urinary retention (RR, 0.61 [95% CI 0.37–0.99]).

Conclusions

Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.

中文翻译：

脊髓与全身麻醉下清醒脊柱手术的结果比较：全面的系统评价和荟萃分析

背景

在神经和脊柱手术中，脊髓麻醉 (SA) 下的清醒手术是全身麻醉 (GA) 下手术的替代方案。在文献中，似乎有一些证据支持与 GA 相比，使用这种麻醉方式的益处。目前，对于脊柱手术中与清醒 SA 和 GA 相关的并发症，明显缺乏更新和全面的综述。因此，我们的目的是对有关该主题的文献进行系统回顾和荟萃分析。

方法

我们进行了系统性检索，以确定从数据库建立到 2023 年 4 月 14 日期间在 PubMed、Medline、Embase 和 Cochrane 数据库中评估脊柱手术中 SA 的研究。感兴趣的结果包括估计失血量、住院时间、手术时间和总体并发症。使用随机效应模型进行荟萃分析。

结果

总共纳入了 38 项研究，评估了 7820 名患者。大多数接受 SA 治疗的手术都是单节段腰椎病例。与清醒患者相比，清醒患者的住院时间（平均差（MD）：− 0.40 天；95% CI − 0.64 至 − 0.17）和手术时间（MD：− 19.17 分钟；95% CI − 29.68 至 − 8.65）显着缩短。 GA 下的患者。 GA 下患者的总体并发症发生率显着高于 SA 下患者（RR，0.59 [95% CI 0.47-0.74]）。 GA 下的患者术后恶心/呕吐 RR（RR，0.60 [95% CI 0.39–0.90]）和尿潴留（RR，0.61 [95% CI 0.37–0.99]）的发生率显着较高。