Regional Anesthesia for Spine Surgery

Intraoperatively, spinal anesthesia has been described for many years as the primary anesthetic technique for patients undergoing surgical procedures of the lumbar spine. Epidural anesthesia as the primary intraoperative anesthetic technique in this patient population has also been described, but less than spinal anesthesia. Epidural analgesia for postoperative pain management after spinal fusions and instrumentation for repair of spinal deformities has also been used successfully. However, regional anesthesia for spine surgery has not become as common as regional anesthesia for other orthopedic procedures. Several potential advantages have been described with spinal anesthesia for spine surgery including decreased pain in the early postoperative period, less postoperative nausea and vomiting, decreased intraoperative blood loss, and fewer position-related complications. Potential complications of regional anesthesia for spine surgery include failure of the regional anesthetic in the prone position, development of a new neurologic deficit postoperatively, intraoperative hypotension caused by sympathetic block, urinary retention, and postoperative spinal headache. Intraoperatively neurologic monitoring is often used during certain spine procedures. Regional anesthesia, either epidural or spinal, has significant impact on the quality of somatosensory evoked potential monitoring.