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Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series

BACKGROUND: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform thes...

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Autores principales: Khan, Muhammad Babar, Kumar, Rajesh, Enam, Syed Ather
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022997/
https://www.ncbi.nlm.nih.gov/pubmed/24843813
http://dx.doi.org/10.4103/2152-7806.130669
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author Khan, Muhammad Babar
Kumar, Rajesh
Enam, Syed Ather
author_facet Khan, Muhammad Babar
Kumar, Rajesh
Enam, Syed Ather
author_sort Khan, Muhammad Babar
collection PubMed
description BACKGROUND: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia. METHODS: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) scores. RESULTS: Five patients had interlaminar decompressions for stenosis alone, while two patients had laminectomies for debulking of tumors. The mean duration of surgery was 79.8 ± 16.6 min, the mean estimated blood loss was 157.1 ± 53.4 ml, the mean dose of local anesthetic was 1.9 ± 0.7 mg/kg, and the mean length of hospital stay after surgery was 3.2 ± 1.2 days. There were no intraoperative complications. The surgery resulted in improved VAS and ODI scores consistent with significant improvement in pain (P = 0.017) and functionality (P = 0.011). CONCLUSIONS: Performing spinal surgery under local anesthesia is a safe and effective alternative when patient's major comorbidities preclude a general anesthetic. For all the seven patients studied, spinal surgery, performed under a local anesthetic, resulted in a statistically significant reduction in pain and improvement in function.
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spelling pubmed-40229972014-05-19 Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series Khan, Muhammad Babar Kumar, Rajesh Enam, Syed Ather Surg Neurol Int Surgical Neurology International: Spine BACKGROUND: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia. METHODS: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) scores. RESULTS: Five patients had interlaminar decompressions for stenosis alone, while two patients had laminectomies for debulking of tumors. The mean duration of surgery was 79.8 ± 16.6 min, the mean estimated blood loss was 157.1 ± 53.4 ml, the mean dose of local anesthetic was 1.9 ± 0.7 mg/kg, and the mean length of hospital stay after surgery was 3.2 ± 1.2 days. There were no intraoperative complications. The surgery resulted in improved VAS and ODI scores consistent with significant improvement in pain (P = 0.017) and functionality (P = 0.011). CONCLUSIONS: Performing spinal surgery under local anesthesia is a safe and effective alternative when patient's major comorbidities preclude a general anesthetic. For all the seven patients studied, spinal surgery, performed under a local anesthetic, resulted in a statistically significant reduction in pain and improvement in function. Medknow Publications & Media Pvt Ltd 2014-04-16 /pmc/articles/PMC4022997/ /pubmed/24843813 http://dx.doi.org/10.4103/2152-7806.130669 Text en Copyright: © 2014 Khan MB http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Surgical Neurology International: Spine
Khan, Muhammad Babar
Kumar, Rajesh
Enam, Syed Ather
Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title_full Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title_fullStr Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title_full_unstemmed Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title_short Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series
title_sort thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: a consecutive case series
topic Surgical Neurology International: Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022997/
https://www.ncbi.nlm.nih.gov/pubmed/24843813
http://dx.doi.org/10.4103/2152-7806.130669
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