Epidural anesthesia as a novel anesthetic technique for anterior lumbar interbody fusion

• Published in: Journal of clinical anesthesia Vol. 23; no. 7; pp. 521 - 526
• Main Authors: Schroeder, Kristopher M., MD, Zahed, Cameron, MD, Andrei, Adi C., PhD, Han, Seungbong, MS, Ford, Michael P., MD, Zdeblick, Thomas A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier; Elsevier Limited
• Subjects: Abdominal surgery; Adult; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, Epidural - methods; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesia: epidural, neuraxial; Anterior lumbar interbody fusion; Back surgery; Biological and medical sciences; Blood Pressure; Female; Hospitals, University; Humans; Intraoperative Period; Intubation; Length of Stay; Lumbar Vertebrae; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Obesity; Orthopedic surgery; Pain; Pain Medicine; Pain, Postoperative - drug therapy; Retrospective Studies; Spinal Fusion - methods; Spinal surgery; Surgery; Time Factors; Treatment Outcome; Anesthesia: epidural, neuraxial; Orthopedic surgery; Spinal surgery; Anterior lumbar interbody fusion; Extradural; Anesthetic; Anesthesia; Anesthesia: epidural neuraxial
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2011.01.008

Abstract Study Objective To determine if epidural anesthesia is a reasonable technique for anterior lumbar interbody fusion. Design Retrospective chart review. Setting Academic university hospital. Measurements The charts of patients who underwent an anterior lumbar interbody fusion between January 1, 2001 and November 1, 2008 were reviewed. A total of 102 consecutive patients, of whom 19 received an epidural and 83 underwent general anesthesia, met inclusion criteria. Postoperative pain, nausea, opioid administration, operating room time, anesthesia time, Postanesthesia Care Unit (PACU) time, and total hospital time were compared. Main Results In the PACU, patients receiving epidural anesthesia showed reductions in median immediate [numerical rating scale (NRS) 0 vs 7; P < 0.001] and peak (NRS 4 vs 8; P = 0.001) postoperative pain scores, and postoperative mean arterial pressure (69.7 vs 90.3; P < 0.001). Epidural anesthesia patients also needed significantly less intravenous morphine-equivalent medication both intraoperatively (5 vs 29; P < 0.001) and postoperatively (3.34 vs 10; P = 0.021). Conclusions Epidural anesthesia for anterior lumbar interbody fusion is potentially beneficial compared with general anesthesia, showing improved perioperative pain control.