Effects of general anesthesia with and without thoracic epidural block on length of stay after open spine surgery: A single-blinded randomized controlled trial

Length of hospital stay (LOS) is an important concern in all types of surgery, and the enhanced recovery after surgery (ERAS) protocol has been developed to improve perioperative management and outcomes, which require multidisciplinary management. In terms of pain control, intraoperative regional an...

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Bibliographic Details
Published in:The spine journal 2022-10, Vol.22 (10), p.1694-1699
Main Authors: Thepsoparn, Marvin, Punyawattanakit, Porranee, Jaruwangsanti, Nara, Singhatanadgige, Weerasak, Chalermkitpanit, Pornpan
Format: Article
Language:English
Subjects:
analgesia
elective surgery
general anesthetic
laminectomy
length of stay
lumbar spine surgery
operative time
opioid-related side effects
recovery
thoracic epidural
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Summary:Length of hospital stay (LOS) is an important concern in all types of surgery, and the enhanced recovery after surgery (ERAS) protocol has been developed to improve perioperative management and outcomes, which require multidisciplinary management. In terms of pain control, intraoperative regional anesthesia and postoperative opioid-sparing analgesia are recommended. For open spine surgery, we aimed to combine thoracic epidural analgesia to reduce pain and opioid-related side effects, thereby hastening recovery. This study aimed to compare the length of hospital stay after open complete laminectomy with fusion between general anesthesia and combined general anesthesia involving a single thoracic epidural injection. A randomized single-blinded controlled study Thirty-eight patients scheduled for elective open laminectomy with fusion between one and three levels were selected. LOS, postoperative pain, patient-controlled morphine consumption at 24 h, patient satisfaction score, and other opioid-related side effects were recorded. Patients were randomly selected to receive standard general anesthesia (GA) or GA combined with a single-shot thoracic epidural at T11-T12 or T12-L1, a block with 10 ml of 0.25% bupivacaine, and 4 mg of morphine. There were no significant differences in the demographic variables between groups. LOS was significantly lower in the combined epidural/GA than in the control group (3.78 ± 0.81 [mean ± standard deviation] and 4.79 ± 1.51 days, respectively; p = 0.017). Numeric rating score (at rest) at the post-anesthesia care unit, 24 h postoperative morphine consumption (mg), operating time, and blood loss were significantly lower in the epidural group. Patients who received combined epidural/GA were more likely to report higher patient satisfaction (p = 0.008). However, the incidence of intraoperative hypotension was significantly higher in the epidural group (72.2% vs. 21.1%, p = 0.003). The incidences of adverse events and surgical field rating scores did not differ between the two patient groups. Combined lower thoracic epidural/GA in patients undergoing elective lumbar spine surgery was associated with decreased LOS.
ISSN:1529-9430
1878-1632
DOI:10.1016/j.spinee.2022.05.015