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Comparison of Epidural Anaesthesia and General Anaesthesia with Caudal Epidural Analgesia for Minimally Invasive Lumbosacral Spine Surgeries

Background: Minimally invasive lumbar spine surgeries have become popular due to less tissue trauma involved and reduced hospital stay. General anaesthesia is more frequently used for these surgeries, though regional anaesthesia is proved to be safe in few studies.

Purpose: To test the efficacy of Epidural anaesthesia (EA) for these lumbosacral spine surgeries in comparison with General anaesthesia supplemented with caudal analgesia (GA).

Method: We randomized 80 patients posted for elective primary minimally invasive lumbosacral decompression spinal procedures into two groups of 40 each. The GA group patients received caudal analgesia with Ropivocaine 0.2% 30 ml with Buprenorphine 75 mcg before incision. The EA group patients received 10 cc of Ropivocaine 0.75% bolus with Buprenorphine 75 mcg through epidural catheter placed two spaces above the surgical incision site. Both groups received IV Paracetamol 1 gm 6th hrly and rescue analgesics given were IV Diclofenac and Tramadol.

Outcome measures: We compared the groups for perioperative haemodynamic variables, anaesthesia and surgical time, postoperative analgesic requirement, PONV and length of hospital stay.

Results: Intraoperative hypotension was seen more in GA group. The surgical and anaesthesia duration were significantly less in EA group. However, the patients for two level discectomies (3 vs. 1) and bilateral laminoforaminotomies (8 vs. 4) were more in GA group. Postoperative analgesic requirement was significantly more in GA group. There was no significant difference in the PONV and all patients were discharged on the first postoperative day.

Conclusion: Epidural anaesthesia can safely replace GA for minimally invasive lumbar spine procedures. It not only avoids the risks of GA, but also the intraoperative blood loss, the duration of anaesthesia and the postoperative IV analgesic requirements are much less with the use of Epidural anaesthesia.


Geetha Lakshminarasimhaiah

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