Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Eur Spine J. 2024 Mar;33(3):985-1000. doi: 10.1007/s00586-023-08071-y. Epub 2023 Dec 19.
Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic.
A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models.
In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): - 0.40 days; 95% CI - 0.64 to - 0.17) and operative time (MD: - 19.17 min; 95% CI - 29.68 to - 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI 0.37-0.99]).
Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
在神经外科和脊柱外科中，椎管内麻醉（SA）下清醒手术是全身麻醉（GA）下手术的替代方法。在文献中，似乎有一些证据支持与 GA 相比，使用这种麻醉方式的益处。目前，对于脊柱外科中清醒 SA 和 GA 相关并发症，缺乏更新和全面的综述。因此，我们旨在对该主题进行系统的文献回顾和荟萃分析。
从数据库创建到 2023 年 4 月 14 日，在 PubMed、Medline、Embase 和 Cochrane 数据库中进行了系统搜索，以确定评估脊柱外科中 SA 的研究。感兴趣的结局包括估计失血量、住院时间、手术时间和总体并发症。使用随机效应模型进行荟萃分析。
共纳入 38 项研究，评估了 7820 例患者。接受 SA 治疗的大多数手术是单节段腰椎手术。与 GA 组相比，清醒患者的住院时间（MD：-0.40 天；95%CI：-0.64 至-0.17）和手术时间（MD：-19.17 分钟；95%CI：-29.68 至-8.65）明显更短。与 GA 相比，GA 组的总体并发症发生率明显更高（RR，0.59 [95%CI 0.47-0.74]）。GA 组术后恶心/呕吐发生率（RR，0.60 [95%CI 0.39-0.90]）和尿潴留发生率（RR，0.61 [95%CI 0.37-0.99]）明显更高。
与 GA 相比，接受清醒脊柱手术的患者手术时间和住院时间明显缩短，术后恶心和尿潴留发生率较低。总之，清醒脊柱手术提供了一种替代 GA 的有效方法，并且在术后并发症方面具有额外的益处，同时相关发病率相对较低。
