Urick David, Sciavolino Brandon, Wang Timothy Y, Gupta Dhanesh K, Sharan Alok, Abd-El-Barr Muhammed M
Duke University School of Medicine, Durham, NC, USA.
Hackensack Meridian School of Medicine, Nutley, NJ, USA.
J Clin Orthop Trauma. 2022 Jun 16;30:101923. doi: 10.1016/j.jcot.2022.101923. eCollection 2022 Jul.
Meta-analysis.
Perform a systematic review and meta-analysis to determine the perioperative utility of general versus spinal anesthesia in the lumbar spine surgery population.
PubMed and Embase were queried for manuscripts reporting perioperative outcomes for patients undergoing one to three-level lumbar spine surgery (including decompression, fusion, and decompression with fusion) using either general or spinal anesthesia. Inclusion criteria included studies published from 2005 to 2021, in English, involving primary data from human subjects. Studies were further screened for data on total operative time, blood loss, intraoperative hypotension, pain scores, postoperative nausea and vomiting, time required in post-anesthesia care unit (PACU), PACU pain anesthetic requirement, and length of stay. Risk of bias for each study was assessed using standardized tools (i.e., RoB 2, ROBINS-I, NOS, as appropriate). Potential predictors of outcome were compared using univariate analysis, and variables potentially associated with outcome were subjected to meta-analysis using Cochran-Mantel-Haenszel testing to produce standard mean differences (SMD) or odds ratios (OR) and 95% confidence intervals (CI).
In total, 12 studies totaling 2796 patients met inclusion criteria. 1414 (50.6%) and 1382 (49.4%) patients underwent lumbar spine surgery with general anesthesia and spinal anesthesia, respectively. Patients undergoing spinal anesthesia were statistically more likely to have coronary artery disease and respiratory dysfunction. Total operative time (SMD: 12.62 min, 95% CI -18.65 to -6.59), estimated blood loss (SMD: 0.57 mL, 95% CI -0.68 to -0.46), postoperative nausea and vomiting (OR = 0.20, 95% CI 0.15 to 0.26), time required in PACU (SMD = -0.20 min, 95% CI -0.32 to -0.08), and length of stay (SMD = -0.14 day, 95% CI -0.18 to -0.10), all statistically significantly favored spinal anesthesia over general anesthesia (p < 0.05).
In one to three-level lumbar spine surgery, current literature supports spinal anesthesia as a viable alternative to general anesthesia. As this was a heterogeneous patient population, prospective randomized trials are needed to corroborate findings.
荟萃分析。
进行系统评价和荟萃分析，以确定全身麻醉与脊髓麻醉在腰椎手术人群中的围手术期效用。
在PubMed和Embase数据库中检索报告使用全身麻醉或脊髓麻醉进行一至三级腰椎手术（包括减压、融合以及减压加融合）患者围手术期结局的手稿。纳入标准包括2005年至2021年发表的英文研究，涉及来自人类受试者的原始数据。进一步筛选研究中的总手术时间、失血量、术中低血压、疼痛评分、术后恶心呕吐、麻醉后护理单元（PACU）所需时间、PACU疼痛麻醉需求以及住院时间等数据。使用标准化工具（即酌情使用RoB 2、ROBINS - I、NOS）评估每项研究的偏倚风险。使用单因素分析比较结局的潜在预测因素，并使用 Cochr an - Mantel - Haenszel检验对可能与结局相关的变量进行荟萃分析，以产生标准均数差（SMD）或比值比（OR）以及95%置信区间（CI）。
总共12项研究、2796例患者符合纳入标准。分别有1414例（50.6%）和1382例（49.4%）患者接受了全身麻醉和脊髓麻醉下的腰椎手术。接受脊髓麻醉的患者在统计学上更有可能患有冠状动脉疾病和呼吸功能障碍。总手术时间（SMD：12.62分钟，95% CI -18.65至 -6.59）、估计失血量（SMD：0.57毫升，95% CI -0.68至 -0.46）、术后恶心呕吐（OR = 0.20，95% CI 0.15至0.26）、PACU所需时间（SMD = -0.20分钟，95% CI -0.32至 -0.08）以及住院时间（SMD = -0.14天，95% CI -0.18至 -0.10），在统计学上均显著支持脊髓麻醉优于全身麻醉（p < 0.05）。
在一至三级腰椎手术中，当前文献支持脊髓麻醉作为全身麻醉的一种可行替代方案。由于这是一个异质性患者群体，需要进行前瞻性随机试验来证实研究结果。
