Complicaciones asocaidas con la laminectomía lumbar. (Inglés)

«Complicaciones asociadas con la laminectomía lumbar: Una comparación entre la anestesia epidural y la general.»

McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ.

Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. mclainr@ccf.org

STUDY DESIGN:
A case-controlled, comparative study of 400 patients undergoing lumbar surgery, treated with either spinal or general anesthesia. An independent observer analyzed outcomes.

OBJECTIVES:
To determine the rate and type, of perioperative complications associated with each anesthetic method among lumbar surgery patients.

SUMMARY OF BACKGROUND DATA:
Spinal anesthesia is infrequently used for spinal procedures. While complications associated with spinal anesthesia are rare, some authors have suggested that spinal anesthesia may exacerbate existing neurologic disease and have recommended against its use in lumbar disc surgery. Others have found the technique safe and effective. General anesthesia may be preferred because it is seen as the routine accepted practice, because of greater patient acceptance and the ability to perform longer operations, or because of a general sense that general anesthesia is «safer» in these procedures.

METHODS:
Patients treated between 1994 and 1998 were matched for anesthetic class, preoperative diagnosis, surgical procedure, and perioperative protocols. All patients were treated according to a uniform protocol and recovered in the same perianesthetic environment. Data from the intraoperative period through hospital discharge were collected and compared.

RESULTS:
A total of 200 patients were included in each group. Overall complication rates and time to discharge were significantly lower in spinal anesthetic patients. Total anesthetic and operative times were significantly longer for general anesthetic patients, and perioperative heart rate and mean arterial pressures were elevated compared with those in spinal anesthetic patients. Nausea, requirements for antiemetic medication, and the incidence of urinary retention were significantly increased among general anesthesia patients. Spinal anesthesia patients had fewer spinal headaches compared with the general anesthetic group, but statistical significance was not obtained.

CONCLUSIONS:
For patients undergoing decompressive lumbar surgery, spinal anesthesia is at least comparable to general anesthetic with respect to complications. Specific advantages to spinal anesthesia include decreased nausea and antiemetic requirements, reduced analgesic requirements, and reduced overall complication rate.

Spine. 2004 Nov 15;29(22):2542-7.

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