Published date: Jul 04 2023

Journal Title: Journal of Spine Practice

Issue title: Journal of Spine Practice (JSP): Volume 2, Issue 2

Pages: 40-50

DOI: 10.18502/jsp.v2i2.13223

David Salvendavid.salven@duke.eduDepartment of Neurosurgery, Duke University Medical Center

David Sykesdavid.sykes@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Melissa Ericksonmelissa.erickson@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Khoi Thankhoi.than@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Peter Grossipeter.grossi@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Clifford Crutcherclifford.crutcher@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Miles Bergermiles.berger@duke.eduDepartment of Anesthesiology, Duke University Medical Center

W. Michael Bullockwilliam.bullock@duke.eduDepartment of Anesthesiology, Duke University Medical Center

Jeff Gadsdenjeff.gadsden@duke.eduDepartment of Anesthesiology, Duke University Medical Center

Muhammad Abd-El-Barrm.abdelbarr@duke.eduDepartment of Neurosurgery, Duke University Medical Center

Background: Regional anesthesia, which refers to the use of anesthetics to provide analgesia to a specific body part or nervous innervation territory, has become increasingly popular in the field of spine surgery. With the application of these techniques, it has been postulated that patients will require less systemic analgesia, intraoperatively and postoperatively. The authors of this narrative review discuss the common regional anesthetic modalities applied to spine surgery, in addition to patient selection criteria, success in patients with multiple comorbid illnesses, and its adoption by surgeons.

Materials and Methods: An advanced search was performed in the PubMed database to obtain Englishlanguage articles discussing regional anesthesia, awake spine surgery, and postoperative complications. Articles were screened for relevance, and 47 articles were incorporated into this narrative review.

Results: Classic neuraxial and paraspinal techniques have allowed surgeons to perform posterior decompression, fusion, and revision procedures. Transversus abdominus plane and quadratus lumborum blocks have enabled better pain control in patients undergoing surgeries requiring anterior or lateral approaches. Documented benefits of regional anesthesia include shorter operative time, improved pain control and hemodynamic stability, as well as decreased cost and length of stay. Several case series have demonstrated the success of these techniques in highly comorbid patients.

Conclusion: Regional anesthesia provides an exciting opportunity to make surgical treatment possible for spine patients with significant comorbidities. Although additional randomized controlled trials are necessary to further refine patient selection criteria, current data demonstrates its safety and efficacy in the operating room.

Keywords: Minimally invasive spine surgery, Awake spine surgery, Spinal anesthesia, Regional anesthesia, General anesthesia, Patient outcomes

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