361 Awake Spinal Fusion Leads to Decreased Postoperative Opioid Use and Decreased Length of Stay Compared to General Anesthesia: A Matched Cohort Study

Abstract

INTRODUCTION: Over the past several years, there has been increasing interest in performing spinal fusion under awake spinal anesthesia (SA) as an alternative to general anesthesia (GA). The evidence supporting its use has been positive, albeit limited. METHODS: The authors performed a retrospective review of a single surgeon’s patients who underwent lumbar interbody fusions under SA vs GA. Each SA patient was compared to a demographically-matched GA counterpart undergoing a comparable procedure by parametric T-tests. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents (MME), time to ambulation (TTA), and length of stay (LOS). RESULTS: 8 SA patients were matched to 8 GA counterparts; the cohort had a mean age of 66.8, a mean BMI of 26.4, and a mean American Society of Anesthesiologists Physical Status (ASA-PS) of 2.81. GA and SA patients demonstrated no statistically significant differences in age, BMI, or ASA-PS. All patients received erector spinae plane blocks with 1.3% liposomal bupivacaine. Postoperative opioid use was reduced in SA patients compared to GA patients (18.86 vs 54.34 MME, p = 0.026). SA patients also demonstrated a shorter hospital LOS (0.52 vs 2.63 days, p = 0.029). SA patients did not demonstrate a statistically significant reduction in procedure duration (138 vs 169 minutes, p = 0.207) nor a statistically significantly reduced TTA (3.85 vs 31.33 hours, p = 0.092). CONCLUSIONS: These preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with lower opioid utilization and reduced hospital length of stay. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.