Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial.

Surgery on the lower thoracic and lumbar spine can be safely performed under general or regional anesthesia. Patients satisfaction and the ability to carry out prolonged operations in the prone position without airway compromise are of advantages of using general anesthesia (GA).1,2 Alternatively, the most important advantages of regional anesthesia are the decrease in intraoperative blood loss and consequently improving operating conditions,3 the decrease in perioperative cardiac ischemic incidents, postoperative hypoxic episodes, arterial and venous thrombosis, and to provide proper postoperative pain control.4–7 Additionally, in order to prevent brachial plexus injury and pressure necrosis of face, it is better if patients can position themselves while they are awake. This is possible only with spinal anesthesia (SA). As Scott et al8 showed, pulmonary complications were more common in patients underwent GA compared with regional anesthesia. Two retrospective studies shown that SA resulted in better outcome compared with GA in patients underwent surgeries on lumbar spine.9,10 An acceptable anesthetic technique must have characteristics such as rapid onset and reversal of effects. Also, it must maintain stable hemodynamic during operation without need to increase blood transfusion. Lastly, an excellent anesthetic must decrease recovery room stay while reduce postoperative pain, nausea, vomiting, and requirement for additional analgesics. As our search in medical literature showed, there are controversies whether SA or GA offers these advantages for lumbar disk surgery. Sadrolsadat et al11 showed that in contrast to the previous studies that revealed SA was better than GA for patients undergoing lower thoracic and lumbar spine surgery, SA had no advantages over GA. They also showed that SA accompanied with more adverse effects compared with GA. They emphasized that further study must be performed before final conclusion elucidated. In the clinical experience, it seems to the authors that patients who underwent lumbar spine surgery with SA have more satisfaction with lower adverse effect compared with those with GA. This is in accordance with the most previous studies but is opposite to Sadrolsadat et al study. For more clarification of this important topic, we designed to run the present study to evaluate both intraoperative and postoperative outcomes after SA or GA techniques, when employed in patients undergoing lumbar spine surgery.