A Survey on the Short-term Outcome of Microlumbar Discectomy with General versus Spinal Anesthesia

BACKGROUND: Surgery on the lower thoracic and lumbosacral spine is possible with both general and spinal anesthesia, but most spine surgeons are reluctant to perform the surgery with spinal anesthesia. We aimed to conduct a survey on the short-term outcome of microlumbar discectomy in the patients who had been treated under general or spinal anesthesia. METHODS: In this prospective study, we performed a survey on 72 patients who underwent microlumbar discectomy under general anesthesia (group A) or spinal anesthesia (group B). Demographic characteristics, American Society of Anesthesiologists physical status, duration of operation, blood loss, and complications were all documented. Preoperative and early postoperative (at the time of discharge) disability and pain were assessed by using Japanese Orthopedic Association (JOA) scoring system and a visual analog scale questionnaire. RESULTS: The two groups were homogenous preoperatively. The mean intraoperative blood loss was less and the mean operating time was shorter in group A than in group B, but there was no statistically significant difference between groups. The rate of postoperative improvement in JOA score and improvement in pain were similar between groups. Anesthetic complications were unremarkable. CONCLUSIONS: Simple lumbar disc operations in the otherwise healthy patients can be safely performed under either spinal or general anesthesia. Both anesthetic methods led to comparable outcomes with minimal complications.

[Painless labor with patient-controlled epidural pumps of bupivacaine and fentanyl]

Epidural anesthesia is an appropriate technique for managing labour pain, which is a common problem in acute pain management. Intact motor function, less hemodynamic changes and decreased maternal catecholamines are the other pearls in epidural anesthesia. Patient Control Epidural Analgesia [PCEA] is a safe and effective technique with minimal motor block, with more patients' satisfaction and stability and least drug requirement for analgesia. Epidural analgesia is the most effective technique among routine methods for labour pain control. In volunteers with vertex position of single fetus which were in active phase of pregnancy epidural catheter was implicated. After loading the first injection doseage; catheters were attached to the disposable silicone balloon pumps, which delivered maximum of 2ml of solution contained 0.1% marcaine plus 4 microgram per milliliter fentanyl every 15 minutes with patient control button. The patients were monitored for pain severity and vital signs. Subsidiary methods and drugs used for pain were also recorded during the labour. 45 parturient entered the study. Mean VAS in 96% was less than 4 during all times. 23 of the mothers [51%] had the score of 5 to 8 in MEPAS scale and were able to walk either with or without any help just 30 minutes after receiving the loading epidural dose. PCEA is a safe and effective method which showed effective pain reduction in 96% of cases