Comparative analysis of the effectiveness and safety of anesthetic care during neurosurgical interventions on the lumbar spine in patients with high-risk factors

Abstract

The effectiveness and safety of providing anesthetic care during neurosurgical interventions on the spine in patients with high-risk factors are compared. The prospective comparative study included patients who had a high operational and anesthesiological risk according to the author’s decision support system (> 8 points). All patients underwent open dorsal decompressive and stabilizing interventions from 2021 to 2023. Depending on the type of anesthesia and method of postoperative analgesia, three groups of patients were distinguished: in Group 1 (n = 41), intravenous anesthesia based on propofol and fentanyl was used; in Group 2 (n = 40), prolonged epidural analgesia with ropivacaine was additionally performed for 3 days after surgery; and in Group 3 (n = 43), multimodal analgesia was combined with preoperative intramuscular administration of ketoprofen and infiltration of the paraspinal muscles, subcutaneous fat, and skin with ropivacaine before access; intraoperative administration of dexmedetomidine; and postoperative administration of paracetamol. Comparative analysis included assessment of perioperative hemodynamic parameters, intensity of postoperative pain, perioperative use of opioids, dynamics of recovery of psychomotor functions, side effects of anesthesia, and postoperative surgical complications. It was found that the patients of Group 3, compared with the patients of Groups 1 and 2, had no significant changes in hemodynamics, obtained better results in the rate of recovery of psychomotor functions, and received a smaller intraoperative amount of opioid drugs. In Groups 2 and 3, a minimum level of postoperative local pain syndrome and a lower need for analgesics were recorded. The number of side effects of anesthesia in Group 1 was 29.3%; in Group 2, 27.5%; and in Group 3, 9.3% (p = 0.01). The number of postoperative surgical complications was comparable: Group 1, 7.3%; Group 2, 7.5%; and Group 3, 4.7% (p = 0.56). Thus, the use of complex perioperative anesthesia, in comparison with traditional anesthesia, including prolonged epidural analgesia, has advantages in the absence of depression of perioperative hemodynamic parameters and fewer side effects of anesthesia and postoperative surgical complications.

Keywords

degenerative disease of the lumbar spine / patients with high operational and anesthetic risk / open decompressive and stabilizing interventions / surgical stress response / accelerated recovery after surgery / ropivacaine / dexmedetomidine / prolonged epidural analgesia

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