Lomber Enstrümantasyon Uygulanan Yaşlı Hastalarda Spinal Anestezi ile Genel Anestezinin Karşılaştırması: Retrospektif Çalışma

Abstract

Objective: Spine surgery poses serious risks in elderly patients due to long operating time and massive blood loss. The aim of the study was to evaluate whether anesthesia techniques (general versus spinal) would have an effect on perioperative outcomes in patients older than 65 years who underwent lumbar instrumentation. Material and Methods: A retrospective review was performed using hospital's database after ethics committee approval. Patients with American Society of Anesthesiologists physical status I-III and aged between 65- 90 years were included in the study who underwent elective primary lumbar instrumentation (1-5 levels) surgery were included in the study. Primary outcome measures were perioperative blood loss, blood transfusion requirement and postoperative pain relief. Secondary outcome measures were hospital discharge time and complications. Results: Forty-five patients received general anesthesia (Group GA) using inhalational sevoflurane combined with intravenous remifentail infusion and 44 patients received spinal anesthesia (Group SA). Blood loss was higher in Group GA than Group SA (470.8±91.1 mL vs. 387.8±100.5 mL, p=0.02). More patients in the Group GA were received packed red blood cell transfusion (16.4% vs. 9.1%, p=0.02). Pain scores were higher (5.6±1.1 vs. 4.0±1.8, p=0.02), in Group GA. Hospital discharge time was longer (4.0±1.0 days vs. 3.0±0.6 days; p=0.02) and complication rate was higher in Group GA (61.8% vs. 29.5%, p=0.01). The most common complication was postoperative nausea and vomiting (18.1%). Conclusion: It is concluded that SA may be performed as a safe and effective alternative for GA in older adults undergoing lumbar instrumentation.