Comparative perioperative narcotic use in tlif patients: Spinal versus general anesthesia in a retrospective cohort study of 180 cases in hospital and ambulatory settings.
Publication Title
Clinical neurology and neurosurgery
Document Type
Article
Publication Date
4-1-2025
Keywords
Humans; Male; Female; Retrospective Studies; Anesthesia, General; Middle Aged; Anesthesia, Spinal; Aged; Pain, Postoperative; Spinal Fusion; Length of Stay; Ambulatory Surgical Procedures; Narcotics; Cohort Studies; Lumbar Vertebrae; Adult; Awake minimally invasive surgery; Hospital stay; Morphine milligram equivalents (MME); Perioperative narcotic utilization; Post-operative length of stay (LOS); Post-operative recovery metrics; Spinal anesthesia vs. General anesthesia; Transforaminal lumbar interbody fusion (TLIF); washington; swedish
Abstract
OBJECTIVES: To implement an integrated anesthesia and surgery protocol of improved postoperative pain control to facilitate transitioning of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) from a hospital to an ambulatory surgery center setting by lowering postoperative (in-facility) narcotic consumption and length of stay (LOS) transitioning from general to awake spinal anesthesia.
METHODS: A retrospective cohort study of 180 patients who received awake or general anesthesia (GA) MI-TLIF from 2017 to 2023.
RESULTS: Among 180 MI-TLIF patients, 101 (56 %) received awake protocol and 79 (44 %) received general anesthesia. Baseline characteristics (age, sex, Charlson comorbidity index (CCI), smoking status) were similar between groups except for body mass index (BMI) and height which was higher in the GA group. ASC patients had a significantly lower CCI (3.25 ± 1.55 vs. 1.33 ± 0.96; p < 0.001). Awake patients had shorter facility LOS and total LOS compared to GA group (Hospital LOS: 25.67 ± 1.77 hours vs 33.91 ± 2.7 hours, p < 0.05; p = 0.009). PACU LOS was shorter in a hospital setting (1.19 ± 0.04 hrs.) than in the ASC (6.68 ± 0.90 hrs.; p < 0.001) since patients could be transferred to a step-down unit after immediate postoperative recovery. The total facility LOS was also significantly extended in inpatients (33.81 ± 1.68 hrs.) versus ASC patients (6.68 ± 0.9045; p < 0.001). Awake patients required less narcotics during their entire post-operative stay compared to GA patients (155.83 ± 15.87 MME vs 258.27 ± 21.18 MME, p < 0.001). Additionally, the awake group had a shorter operative time compared to the GA group (2.43 ± 0.10 hours vs. 2.93 ± 0.05 hours, p < 0.001).
CONCLUSION: Awake MI-TLIF procedure with spinal anesthesia is associated with shorter post-operative LOS, less post-operative narcotic use, and shorter operative time compared to MI-TLIF under GA. Awake spinal anesthesia facilitates performing MI-TLIF in an ASC due to lower narcotic requirements.
Area of Special Interest
Neurosciences (Brain & Spine)
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Anesthesiology
DOI
10.1016/j.clineuro.2025.108840
