Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):283-290. doi: 10.1227/ons.0000000000000497. Epub 2022 Nov 28.
Spinal anesthesia is safe and effective in lumbar surgeries, with numerous advantages over general anesthesia (GA). Nevertheless, 1 major concern preventing the widespread adoption of this anesthetic modality in spine surgeries is the potential for intraprocedural anesthetic failure, resulting in the need to convert to GA intraoperatively.
To present a novel additional prone dose algorithm for when a first spinal dose fails to achieve the necessary effect.
A total of 422 consecutive patients undergoing simple and complex thoracolumbar surgeries under spinal anesthesia were prospectively enrolled into our database. Data were retrospectively collected through extraction of electronic health records.
Sixteen of 422 required a second prone dose, of whom 1 refused and was converted to GA preoperatively. After 15 were given a prone dose, only 2 required preoperative conversion to GA. There were no instances of intraoperative conversion to GA. The success rate for spinal anesthesia without the need for conversion rose from 96.4% to 99.5%. In patients who required a second prone dose, there were no instances of spinal headache, deep vein thrombosis, pneumonia, urinary tract infection, urinary retention, readmission within 30 days, acute pain service consult, return to operating room, durotomy, or cerebrospinal fluid on puncture.
Use of an additional prone dose algorithm was able to achieve a 99.5% success rate, and those who received this second dose did not experience any complications or negative operative disadvantages. Further research is needed to investigate which patients are at increased risk of inadequate analgesia with spinal anesthesia.
椎管内麻醉在腰椎手术中安全有效，相对于全身麻醉（GA）有许多优势。然而，椎管内麻醉在脊柱手术中尚未广泛应用的一个主要原因是术中可能出现麻醉失败，需要转为 GA。
提出一种新的附加俯卧位剂量算法，用于首次椎管内麻醉剂量未能达到必要效果时。
我们前瞻性地将 422 例连续接受椎管内麻醉下单纯和复杂胸腰椎手术的患者纳入数据库。通过提取电子病历来回顾性收集数据。
422 例患者中有 16 例需要第二次俯卧位剂量，其中 1 例拒绝并在术前转为 GA。15 例患者给予俯卧位剂量后，仅 2 例需要术前转为 GA。术中无转为 GA 者。无需转换为 GA 的椎管内麻醉成功率从 96.4%上升至 99.5%。需要第二次俯卧位剂量的患者无一例出现脊髓头痛、深静脉血栓形成、肺炎、尿路感染、尿潴留、30 天内再入院、急性疼痛服务咨询、返回手术室、硬脊膜切开术或穿刺时脑脊液漏。
使用附加俯卧位剂量算法可达到 99.5%的成功率，接受第二次剂量的患者未出现任何并发症或手术不利影响。需要进一步研究哪些患者椎管内麻醉镇痛不足的风险增加。
