A standardized anesthetic/analgetic regimen compared to standard anesthetic/analgetic regimen for patients with high-risk factors undergoing open lumbar spine surgery: a prospective comparative single-center study

April 25, 2023

doi: 10.1007/s10143-023-02005-4.

Affiliations

¹ Department of Neurosurgery, Irkutsk State Medical University, 1 Krassnogo Vosstaniya Street, off 201, 664003, Irkutsk, Irkutskaya Oblast, Russia. [email protected].
² Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia. [email protected].
³ Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia. [email protected].
⁴ Department of Neurosurgery, Irkutsk State Medical University, 1 Krassnogo Vosstaniya Street, off 201, 664003, Irkutsk, Irkutskaya Oblast, Russia.
⁵ Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
⁶ Department of Orthopedic Surgery, Columbia University, New York, USA.
⁷ Department of Neurological Surgery, Weill Cornell Medical College, New York, USA.

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Vadim A Byvaltsev et al.

Neurosurg Rev.

2023.

doi: 10.1007/s10143-023-02005-4.

Affiliations

¹ Department of Neurosurgery, Irkutsk State Medical University, 1 Krassnogo Vosstaniya Street, off 201, 664003, Irkutsk, Irkutskaya Oblast, Russia. [email protected].
² Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia. [email protected].
³ Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia. [email protected].
⁴ Department of Neurosurgery, Irkutsk State Medical University, 1 Krassnogo Vosstaniya Street, off 201, 664003, Irkutsk, Irkutskaya Oblast, Russia.
⁵ Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
⁶ Department of Orthopedic Surgery, Columbia University, New York, USA.
⁷ Department of Neurological Surgery, Weill Cornell Medical College, New York, USA.

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Abstract

The objective of the study is to improve the results of patients undergoing lumbar spine surgery who are at high risk for anesthesia and/or surgical complications. Two independent groups were compared: the study group (SG, n = 40) (standardized neuroanesthetic protocol with multimodal analgesia) and the control group (CG, n = 40) (intravenous anesthesia based on propofol and fentanyl). The data were collected using prospective observation of early and long-term results of lumbar fusion. After 24 months, the level of functional state and quality of life were studied. Patients in the SG did not have statistically significant changes in intraoperative hemodynamics; the best indicators of cognitive functions were noted. The effectiveness of the SG compared with the CG was confirmed by a statistically significantly lower amount of perioperative opioid drugs required (p = 0.01) and a minimal level of incisional pain (p < 0.05). An intergroup comparison of the adverse effects of anesthesia revealed a significantly lower number in the SG (n = 4) compared to the CG (n = 16) (p = 0.004). The number of postoperative surgical complications was comparable (p = 0.72). Intergroup comparison showed improved ODI, SF-36, and the Macnab scale at 24 months after surgery in the SG compared to the CG (p < 0.05). Long-term clinical results correlated with the level of incisional pain in the first three postoperative days. Our standardized neuroanesthetic protocol ensured effective treatment of postoperative incisional pain, significantly decreased the perioperative use of opioids, reduced adverse anesthesia events, and improved long-term clinical results in patients with high risk factors for anesthetic complications who undergoing open lumbar spine surgery.

Keywords:

Comorbidity; Degenerative disease; Dexmedetomidine; ERAS; Elderly; Lumbar spine; Open decompression-stabilization interventions; Overweight; Ropivacaine; Surgical stress response.

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