Boykov Nikolay, Ferdinandov Dilyan, Vasileva Petra, Yankov Dimo, Burev Stefan, Tanova Rositsa
Department of Anesthesiology and Intensive Care, St. Ivan Rilski University Hospital, Sofia, Bulgaria.
Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria.
Front Med (Lausanne). 2024 Apr 11;11:1387935. doi: 10.3389/fmed.2024.1387935. eCollection 2024.
Spinal anesthesia (SA) is a good alternative to general anesthesia (GA) for spine surgery. Despite that, a few case series concern the use of thoracic spinal anesthesia for short-duration surgical interventions. In search of an alternative approach to GA and a better opioid-free modality, we aimed to investigate the safety, feasibility, and patient satisfaction of thoracic SA for spine surgery.
We analyzed retrospectively a cohort of 24 patients operated on for a degenerative and osteoporotic pathology of the lower thoracic and lumbar spine. Data was collected from medical records, including clinical notes, operative and anesthesia records, and patient questionnaires.
Twenty-one surgeries for herniated discs, two for degenerative spinal stenosis, and one for multi-level osteoporotic vertebral body fractures were performed under spinal anesthesia with intrathecal sedation. In all cases, we applied 0.5% isobaric bupivacaine and the following adjuvants: midazolam, clonidine or dexmedetomidine, and dexamethasone. We boosted the anesthesia with local ropivacaine due to inefficient sensory block in two patients. Nobody in the cohort received intravenous opioids, non-steroidal anti-inflammatory drugs, or additional sedation intraoperatively. Postoperative painkillers were upon the patient's request. No significant complications were detected.
Thoracic spinal anesthesia incorporating adjuvants such as midazolam, clonidine or dexmedetomidine, and dexamethasone demonstrates not only efficient conditions for spine surgery, a favorable safety profile, high patient satisfaction, and intrathecal sedation but also effective opioid-free pain management.
对于脊柱手术，脊髓麻醉（SA）是全身麻醉（GA）的良好替代方案。尽管如此，仍有一些病例系列涉及将胸段脊髓麻醉用于短期手术干预。为了寻找GA的替代方法和更好的无阿片类药物模式，我们旨在研究胸段SA用于脊柱手术的安全性、可行性和患者满意度。
我们回顾性分析了一组24例因下胸段和腰椎退行性及骨质疏松性病变接受手术的患者。数据从病历中收集，包括临床记录、手术和麻醉记录以及患者问卷。
在脊髓麻醉联合鞘内镇静下进行了21例椎间盘突出症手术、2例退行性脊柱狭窄手术和1例多节段骨质疏松性椎体骨折手术。在所有病例中，我们使用了0.5%的等比重布比卡因以及以下辅助药物：咪达唑仑、可乐定或右美托咪定，以及地塞米松。由于两名患者感觉阻滞效果不佳，我们用局部罗哌卡因加强了麻醉。该队列中无人在术中接受静脉阿片类药物、非甾体抗炎药或额外的镇静。术后止痛药根据患者需求使用。未检测到明显并发症。
采用咪达唑仑、可乐定或右美托咪定以及地塞米松等辅助药物的胸段脊髓麻醉不仅为脊柱手术提供了有效的条件、良好的安全性、较高的患者满意度和鞘内镇静，还实现了有效的无阿片类药物疼痛管理。
