Lessing Noah L, Edwards Charles C, Brown Charles H, Ledford Emily C, Dean Clayton L, Lin Charles, Edwards Charles C
Orthopedics. 2017 Mar 1;40(2):e317-e322. doi: 10.3928/01477447-20161219-01. Epub 2016 Dec 28.
Spinal anesthesia is increasingly viewed as a reasonable alternative to general anesthesia for lumbar spine surgery. However, the results of spinal anesthesia in elderly patients undergoing lumbar spine decompression and combined decompression and fusion procedures are limited in the literature. The aim of this study was to report a single institution's experience using spinal anesthesia in elderly patients undergoing lumbar spine surgery. A retrospective review was conducted using a prospectively collected database of consecutive lumbar spine surgeries performed under spinal anesthesia in patients 70 years or older at a single center between December 2013 and October 2015. A total of 56 patients were included in the study; 27 patients (48%) underwent lumbar decompression and 29 patients (52%) underwent combined decompression and fusion procedures. Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, 1-10). Nausea occurred in 21% (12 of 56) of the patients. Mean length of stay was 2.4 days (range, 1-6 days). No mortality, stroke, permanent loss of function, or pulmonary embolism occurred. None of the cases required conversion to general anesthesia. All of the patients were ambulatory on either the day of the surgery or the next morning. These results demonstrate that spinal anesthesia is a viable method of anesthesia for patients 70 years and older undergoing lumbar spine surgery. They also demonstrate the safety of this method for patients older than 84 years and for surgeries lasting up to 3½ hours. [Orthopedics. 2017; 40(2):e317-e322.].
对于腰椎手术，脊髓麻醉越来越被视为全身麻醉的合理替代方案。然而，老年患者接受腰椎减压以及减压融合联合手术时脊髓麻醉的效果在文献中的报道有限。本研究的目的是报告一家机构在老年患者腰椎手术中使用脊髓麻醉的经验。我们使用一个前瞻性收集的数据库进行回顾性分析，该数据库包含了2013年12月至2015年10月期间在单一中心接受脊髓麻醉的70岁及以上患者连续进行腰椎手术的情况。共有56例患者纳入研究；27例患者（48%）接受了腰椎减压手术，29例患者（52%）接受了减压融合联合手术。平均手术时间为101分钟（范围30 - 210分钟），平均术中失血量为187毫升（范围20 - 700毫升）。术后住院期间视觉模拟量表评分的平均最高值为6.2（范围1 - 10）。21%（56例中的12例）的患者出现恶心。平均住院时间为2.4天（范围1 - 6天）。未发生死亡、中风、永久性功能丧失或肺栓塞。所有病例均无需转为全身麻醉。所有患者在手术当天或次日早晨即可下床活动。这些结果表明，脊髓麻醉对于70岁及以上接受腰椎手术的患者是一种可行的麻醉方法。它们还证明了该方法对于84岁以上患者以及长达3.5小时手术的安全性。[《骨科》。2017；40(2):e317 - e322。]
