GENERAL ANAESTHESIA VS SPINAL ANAESTHESIA FOR SINGLE LEVEL TRANSFORAMINAL LUMBAR INTERBODY FUSION – A RETROSPECTIVE OBSERVATIONAL STUDY OF 40 CASES.

Abstract

General anaesthesia vs Spinal anaesthesia for single level transforaminal lumbar interbody fusion – a retrospective observational study of 40 cases.
Objective: To assess the peri-operative outcomes of single level transforaminal lumbar interbody fusion under Spinal anaesthesia vs General anaesthesia.
Methods: first 20 cases each of single level dynamic L4-L5/ L5-S1 instability between age of 20 to 70 years who got operated by a single senior spine surgeon with transforaminal lumbar interbody fusion under spinal anaesthesia and under general anaesthesia between October 2020 to October 2022 were included in the study. All patients failed to respond to the conservative treatment for at-least 6 weeks. Routine steps for spinal anaesthesia and general anaesthesia were adhered. Total operating Room (OR) time, 3-hour post-anaesthesia care unit (PACU) numeric rating scale (NRS) pain score, post-operative rescue analgesic medication, and time to first ambulation and peri-operative adverse events were compiled and assessed. Appropriate statistical analysis was applied.
Results: Clinically the two groups were homogeneous in characteristics. Total OR time was found to be lesser for patients who underwent TLIF under SA, with a mean OR time of 195.5 +/- 10.11 minutes versus 214.6 +/- 21.3 minutes for patients who underwent TLIF under GA (p < 0.0001), a reduction of 9 %. The total procedure time was comparable in two groups. Post operative nausea and vomiting was found to be significantly higher in GA group. The mean NRS pain score during the first 3 hours in the PACU was different as patients who received SA reported a lower pain score compared with those who received GA (2.5 +/- 2.2 vs 4.6 +/- 1.5; p = 0.001). No significant difference was observed in rescue analgesic received by the two groups. Patients who received SA had a shorter time to first ambulation compared with those who received GA (403 +/- 211 minutes vs 922 +/- 430 minutes; p < 0.0001).
Conclusion: Spinal anaesthesia is safe and effective for performing single level lower lumbar interbody fusion with advantages of reduced perioperative time, early ambulation and lesser complications and cost effective.