Local anesthetic with sedation is a viable alternative to general anesthesia for lumbar spinal decompressions: A retrospective cohort feasibility study and short-term analysis of outcomes

Abstract

Background: An increasing focus on value-based care in spine surgery has prompted interest in alternative anesthetics. Avoidance of general anesthesia (GA) has gained support due to reductions in postoperative symptoms. Little has been published on local anesthesia with sedation techniques. Methods: A retrospective chart review was performed to compare outcomes of lumbar decompression using local anesthesia with light intravenous sedative (LIS) and lumbar decompression using general anesthesia. Outcomes reported were 90-day adverse events, reoperations, and narcotic use. Results: A total of 65 patients who underwent lumbar decompression were identified. Patients receiving LIS were older and had more comorbidities compared with those receiving GA. Rates of peripheral vascular disease and peptic ulcer disease were higher in patients receiving LIS (P=0.004 and 0.012, respectively). The overall rate of postoperative adverse events was 30% lower in patients with LIS. There were no aborted procedures in the LIS cohort. Rates of reoperation trended towards being lower in LIS (14.3%) versus the GA group (37.8%). There was no difference in postoperative narcotic use (LIS 17.9%, GA 24.3%, P=0.530). After adjusting for age, gender, body mass index, Charlson Comorbidity Index, and peripheral vascular disease, the rate of adverse events remained lower in the LIS group (odds ratio: 0.166 [95% CI: 0.037, 0.617], P=0.011), and the trends towards lower rates of recurrent stenosis (P=0.082) and reoperation (P=0.082) remained. There was still no difference in the rate of postoperative narcotic use beyond the first follow-up (P=0.542). Conclusions: Lumbar spinal decompressions are commonly performed surgeries, and they are increasingly being performed in outpatient settings. We conclude that LIS is a safe alternative to GA. Further work is needed to identify cost savings in LIS spine surgery and define patient characteristics that identify appropriate candidates. Level of Evidence: Level III.