A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery: A Meta-Analysis of Randomized Studies.

BACKGROUND: General anesthesia (GA) is commonly used for lumbar spine surgery. The advantages of regional anesthesia (RA) for lumbar spine surgery, as compared with GA, remain unclear. The aim of this meta-analysis was to determine the impact of the type of anesthesia on intraoperative events, incidence of postoperative complications, and recovery time of patients undergoing lumbar spine surgery.

METHODS: Major databases (PubMed, EMBASE, Cochrane library, ISI Web of Science, and Google Scholar) were systematically searched for randomized clinical trials comparing regional versus GA for lumbar spine surgery. Study-level characteristics, intraoperative events, and postoperative complications were extracted from the articles. Meta-analysis was performed using random-effect models.

RESULTS: Fifteen randomized clinical trials comprising 961 patients were included in this meta-analysis. The use of RA for lumbar spine surgery was significantly associated with lower incidence of postoperative nausea and vomiting at 24 hours (risk ratio [RR]=0.42; 95% confidence interval [CI]=0.23-0.77, P=0.005), as well as lower length of stay (standardized mean difference [SMD]=-0.73; 95% CI=-1.17 to -0.29, P=0.001) and intraoperative blood loss (SMD=-1.24; 95% CI=-2.27 to -0.21, P=0.02). There was no statistically significant association with lower pain score (SMD=-0.47; 95% CI=-2.13 to 1.19, P=0.58), lower incidence of urinary retention (RR=1.16; 95% CI=0.73-1.86, P=0.53) or analgesic requirement (RR=0.87; 95% CI=0.64-1.18, P=0.37).

CONCLUSIONS: In summary, RA has several advantageous characteristics, including lower incidence of postoperative nausea and vomiting, length of stay, and blood loss. Further well-designed studies with more sample size are needed to clarify the associations with possible neurological complications.