Skip to main content
SpringerLink
Log in

Regional Anesthesia in Patients with Spine Pain

  • Chapter
  • First Online:
Spine Pain Care

  • 1568 Accesses

Abstract

Regional anesthesia has increasing applications in the perioperative setting, and for patients with spine pain, these techniques can be crucial for preoperative, intraoperative, and postoperative pain management. Patients with spine pain often present for both spine-related and non-spine, non-orthopedic surgeries. In the perioperative setting, analgesia can be challenging for patients with spine pain, as they may be tolerant to many pain medications, and report higher pain levels both at baseline and after surgery. Nonetheless, the appropriate use of regional anesthesia can provide excellent, targeted pain control perioperatively, in a variety of settings. Regional anesthesia can also be used as primary anesthetics for patients with chronic pain presenting for both spine and non-spine surgeries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. In: BOX 64-2: preoperative considerations and recommendations in patients with chronic pain. 8th ed. Philadelphia: Elsevier; 2016. p. 1915.

    Google Scholar 

  2. Farrell C, McConaghy P. Perioperative management of patients taking treatment for chronic pain. BMJ. 2012;345:e4148.

    PubMed  Google Scholar 

  3. Kopf A, Banzhaf A, Stein C. Perioperative management of the chronic pain patient. Best Pract Res Clin Anaesthesiol. 2005;19:59–76.

    PubMed  Google Scholar 

  4. Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. In: BOX 64-3: intraoperative and postoperative management issues and practical recommendations in patients with chronic pain. 8th ed. Philadelphia: Elsevier; 2016. p. 1916.

    Google Scholar 

  5. Mergeay M, Verster A, Aken DV, Vercauteren M. Regional versus general anesthesia for spine surgery; a comprehensive review. Acta Anaesthesiol Belg. 2015;66:1–9.

    CAS  PubMed  Google Scholar 

  6. Goddard M, Smith PD. Spinal anaesthesia for spinal surgery. Anaesthesia. 2006;61:714–26.

    Google Scholar 

  7. Riegel B, Alibert F, Becq MC, Duckert I, Krivosic-Horber R. Lumbar disk herniation with surgical option: general versus local anesthesia. Agressologie. 1994;34 Spec No 1:33–7.

    CAS  PubMed  Google Scholar 

  8. Greenbarg P, Brown M, Pallares V, Tompkins J, Mann H. Epidural anesthesia for lumbar spine surgery. J Spinal Disord. 1988;1(2):139–43.

    CAS  PubMed  Google Scholar 

  9. De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39–43.

    PubMed  Google Scholar 

  10. Jellish WS, Thalji Z, Stevenson K, Shea J. A prospective randomized study comparing short- and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery. Anesth Analg. 1996;83:559–64.

    CAS  PubMed  Google Scholar 

  11. Jellish WS, Abodeely A, Fluder EM, Shea J. The effect of spinal bupivacaine in combination with either epidural clonidine and/or 0.5% bupivacaine administered at the incision site on postoperative outcome in patients undergoing lumbar laminectomy. Anesth Analg. 2003;96(3):874–80.

    PubMed  Google Scholar 

  12. Tetzlaff JE, O’Hara J, Bell G, Grimm K, Yoon HJ. Influence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spinal surgery. Reg Anesth. 1995;20(6):533–7.

    CAS  PubMed  Google Scholar 

  13. Tetzlaff JE, Dilger JA, Kodsy M, al-Bataineh J, Yoon HJ, Bell GR. Spinal anesthesia for elective lumbar spine surgery. J Clin Anesth. 1998;10(8):666–9.

    CAS  PubMed  Google Scholar 

  14. Dagher C, Naccache N, Narchi P, Hage P, Antakly MC. Regional anesthesia for lumbar microdiscectomy. J Med Liban. 2002;50(5–6):206–10.

    PubMed  Google Scholar 

  15. McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine (Phila Pa 1976). 2004;29(22):2542–7.

    Google Scholar 

  16. McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine. 2005;2:17–22.

    PubMed  Google Scholar 

  17. McLain RF, Tetzlaff JE, Bell GR, Uwe-Lewandrowski K, Yoon HJ, Rana M, et al. Microdiscectomy: spinal anesthesia offers optimal results in general patient population. J Surg Orthop Adv. 2007;16(1):5–11.

    PubMed  Google Scholar 

  18. Sadrolsadat SH, Mahdavi AR, Moharari RS, Khajavi MR, Khashayar P, Najafi A, et al. A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgery: a study of 100 cases. Surg Neurol. 2009;71:60–5.

    PubMed  Google Scholar 

  19. Attaria MA, Mirhosseinib SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. JRMS. 2011;16(4):524–9.

    Google Scholar 

  20. Singeisen H, Hodel D, Schindler C, Frey K, Eichenberger U, Hausmann ON. Significantly shorter anesthesia time for surgery of the lumbar spine: processanalytical comparison of spinal anesthesia and intubation narcosis. Anaesthesist. 2013;62(8):632–8.

    CAS  PubMed  Google Scholar 

  21. Erbas YC, Pusat S, Yılmaz E, Bengisun ZK, Erdogan E. Posterior lumbar stabilization surgery under spinal anesthesia for high-risk patients with degenerative spondylolisthesis, spinal stenosis and lumbar compression fracture. Turk Neurosurg. 2015;25(5):771–5.

    PubMed  Google Scholar 

  22. Dagistan Y, Okmen K, Dagistan E, Guler A, Ozkan N. Lumbar microdiscectomy under spinal and general anesthesia: a comparative study. Turk Neurosurg. 2015;25(5):685–9.

    PubMed  Google Scholar 

  23. Lessing NL, Edwards CC 2nd, Brown CH 4th, Ledford EC, Dean CL, Lin C, et al. Spinal anesthesia in elderly patients undergoing lumbar spine surgery. Orthopedics. 2017;40(2):e317–22.

    PubMed  Google Scholar 

  24. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003;15(3):185–92.

    PubMed  Google Scholar 

  25. Yoshimoto H, Nagashima K, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T. A prospective evaluation of anesthesia for posterior lumbar spine fusion: the effectiveness of preoperative epidural anesthesia with morphine. Spine (Phila Pa 1976). 2005;30(8):863–9.

    Google Scholar 

  26. Papadopoulos EC, Girardi FP, Sama A, Pappou IP, Urban MK, Cammisa FP Jr. Lumbar microdiscectomy under epidural anesthesia: a comparison study. Spine J. 2006;6:561–4.

    PubMed  Google Scholar 

  27. Yoshikawa H, Andoh T, Tarumoto Y, Yamada R, Akihisa Y, Kudoh I. Usefulness of epidural anesthesia for percutaneous endoscopic lumbar discectomy (PELD). Masui. 2011;60(12):1370–7.

    PubMed  Google Scholar 

  28. Khajavi MR, Asadian MA, Imani F, Etezadi F, Moharari RS, Amirjamshidi A. General anesthesia versus combined epidural/general anesthesia for elective lumbar spine disc surgery: a randomized clinical trial comparing the impact of the two methods upon the outcome variables. Surg Neurol Int. 2013;4:105.

    PubMed  PubMed Central  Google Scholar 

  29. Akakin A, Yilmaz B, Akay A, Sahin S, Eksi MS, Konya D. Epidural anesthesia in elective lumbar microdiscectomy surgery: is it safe and effective? Turk Neurosurg. 2015;25(1):117–20.

    PubMed  Google Scholar 

  30. Albayrak S, Erol FS, Demirel I, Ayden O, Ucler N. Lumbar disc surgery with epidural anesthesia: review of 700 cases. Turk Neurosurg. 2016;26(3):399–403.

    PubMed  Google Scholar 

  31. Ezhevskaya AA, Mlyavykh SG, Anderson DG. Effects of continuous epidural anesthesia and postoperative epidural analgesia on pain management and stress response in patients undergoing major spinal surgery. Spine. 2013;38:1324–30.

    PubMed  Google Scholar 

  32. Ezhevskaia AA, Prusakova ZB, Maksimova LP, Sholkina MN, Balmusova EA, Ovechkin AM. Effects of epidural anesthesia on stress-induced immune suppression during major corrective spine surgery. Anesteziol Reanimatol. 2014;59(6):4–9.

    CAS  PubMed  Google Scholar 

  33. Vural C, Yorukoglu D. Comparison of patient satisfaction and cost in spinal and general anesthesia for lumbar disc surgery. Turk Neurosurg. 2014;24(3):380–4.

    PubMed  Google Scholar 

  34. Kahveci K, Doger C, Ornek D, Gokcinar D, Aydemir S, Ozay R. Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery. Neurol Neurochir Pol. 2014;48(3):167–73.

    PubMed  Google Scholar 

  35. Walcott BP, Khanna A, Yanamadala V, Coumans JV, Peterfreund RA. Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis. J Clin Neurosci. 2015;22:539–43.

    PubMed  Google Scholar 

  36. Ulutas M, Secer M, Taskapilioglu O, Karadas S, Akyilmaz AA, Yunus Baydilek Y, et al. General versus epidural anesthesia for lumbar microdiscectomy. J Clin Neurosci. 2015;22:1309–13.

    PubMed  Google Scholar 

  37. Agarwal P, Pierce J, Welch WC. Cost analysis of spinal versus general anesthesia for lumbar discectomy and laminectomy spine surgery. World Neurosurg. 2016;89:266–71.

    PubMed  Google Scholar 

  38. Redhu S, Dash HH, Vaishya S. Paravertebral block: sole anesthetic technique for lumbar discectomy in a patient with limited cardiac reserve. J Neurosurg Anesthesiol. 2015;27(3):266–7.

    PubMed  Google Scholar 

  39. Ohgoshi Y, Izawa H, Kori S, Matsukawa M. Multifidus cervicis plane block is effective for cervical spine surgery. Can J Anesth. 2017;64:329–30.

    PubMed  Google Scholar 

  40. Matsunami S, Komasawa N, Fujiwara S, Fujitate Y, Soen M, Minami T. Anesthetic management using frontal nerve, greater occipital nerve, and superficial cervical plexus block for posterior cervical spinal fusion in a patient with athetoid cerebral palsy. Masui. 2015;64(5):549–51.

    PubMed  Google Scholar 

  41. Ueshima H, Otake H. Clinical experience of ultrasound-guided lateral thoracolumbar interfascial plane (TLIP) block. J Clin Anesth. 2017;39:145.

    PubMed  Google Scholar 

  42. Ueshima H, Hiroshi O. Clinical experiences of the continuous thoracolumbar interfascial plane (TLIP) block. J Clin Anesth. 2016;34:555–6.

    PubMed  Google Scholar 

  43. Jeff L, Xu MD. Paraneuraxial nerve blocks: a well-defined novel terminology that is clinically essential for regional anesthesia. J Clin Anesth. 2017;43:14.

    Google Scholar 

  44. Wang H, Ma L, Yang D, Wang T, Wang Q, Zhang L, et al. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: a randomized clinical trial. Medicine (Baltimore). 2017;96(7):e6119.

    CAS  Google Scholar 

  45. Mariappan R, Mehta J, Massicotte E, Nagappa M, Manninen P, Venkatraghavan L. Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial. Can J Anesth. 2015;62:883–90.

    PubMed  Google Scholar 

  46. Laakso E, Pitkänen M, Kyttä J, Rosenberg PH. Knee-chest vs horizontal side position during induction of spinal anesthesia in patients undergoing lumbar disc surgery. Br J Anesth. 1997;79:609–11.

    CAS  Google Scholar 

  47. Yilmaz C, Buyrukcu SO, Cansever T, Gulsen S, Altinors N, Caner H. Lumbar microdiscectomy with spinal anesthesia. Spine. 2010;35(11):1176–84.

    PubMed  Google Scholar 

  48. Sahin AS, Turker G, Bekar A, Bilgin H, Korfalı G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. Eur Spine J. 2014;23:695–700.

    PubMed  Google Scholar 

  49. Salem RA, Darweesh EI, Wanis MA, Mohamed AA. Evaluation of the effects of intrathecal bupivacaine-dexmedetomidine for lumbar spine fusion: a double blinded randomized controlled study. Eur Rev Med Pharmacol Sci. 2015;19:4542–8.

    CAS  PubMed  Google Scholar 

  50. Rung GW, Williams D, Gelb DE, Grubb M. Isobaric spinal anesthesia for lumbar disk surgery. Anesth Analg. 1997;84(5):1165–6.

    CAS  PubMed  Google Scholar 

  51. Dagher C, Naccache N, Narchi P, Hage P, Antakly MC. Regional anesthesia for lumbar microdiscectomy. J Med Liban. 2002;50(5–6):206–10.

    PubMed  Google Scholar 

  52. Nicassio N, Bobicchio P, Umari M, Tacconi L. Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: a prospective study. J Clin Neurosci. 2010;17(12):1537–40.

    PubMed  Google Scholar 

  53. Duger C, Gursoy S, Karadag O, Kol IO, Kaygusuz K, Ozal H, et al. Anesthetic and analgesic effects in patients undergoing a lumbar laminectomy of spinal, epidural or a combined spinal–epidural block with the addition of morphine. J Clin Neurosci. 2012;19:406–10.

    CAS  PubMed  Google Scholar 

  54. Chen HT, Tsai CH, Chao SC, Kao TH, Chen YJ, Hsu HC, et al. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: prospective controlled study under local and general anesthesia. Surg Neurol Int. 2011;2:93.

    PubMed  PubMed Central  Google Scholar 

  55. Sairyo K, Egawa H, Matsuura T, Takahashi M, Higashino K, Sakai T, et al. State of the art: transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Investig. 2014;61(3–4):217–25.

    Google Scholar 

  56. Jha SC, Tonogai I, Takata Y, Sakai T, Higashino K, Matsuura T, et al. Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report. J Med Investig. 2015;62(1–2):100–2.

    Google Scholar 

  57. Telfeian AE, Choi DB, Aghion DM. Transforaminal endoscopic surgery under local analgesia for ventral epidural thoracic spinal tumor: case report. Clin Neurol Neurosurg. 2015;134:1–3. https://doi.org/10.1016/j.clineuro.2015.03.022. Epub 2015 Apr 4.

    Article  PubMed  Google Scholar 

  58. Yamashita K, Higashino K, Sakai T, Takata Y, Abe M, Morimoto M, et al. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: a case report. J Med Investig. 2016;63(1–2):135–9.

    Google Scholar 

  59. Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus. 2016;40(2):E13.

    PubMed  Google Scholar 

  60. Sanusi T, Davis J, Nicassio N, Malik I. Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: a single centre’s experience using the far lateral approach. Clin Neurol Neurosurg. 2015;139:324–7.

    CAS  PubMed  Google Scholar 

  61. Fang G, Ding Z, Song Z. Comparison of the effects of epidural anesthesia and local anesthesia in lumbar transforaminal endoscopic surgery. Pain Physician. 2016;19:E1001–4.

    PubMed  Google Scholar 

  62. Emre TY, Gökcen HB, Atbaşı Z, Kavadar G, Enercan M, Ozturk C. ASA III osteoporotic fracture in 62 patients treated with vertebroplasty under local anesthesia. Eur J Orthop Surg Traumatol. 2016;26(1):47–52.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Peter Lougheed Centre, University of Calgary, Calgary, AB, Canada

    Linda Hung

  2. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jingping Wang

Authors
  1. Linda Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jingping Wang .

Editor information

Editors and Affiliations

  1. Richard J. Kitz Professor of Anesthesia Research Harvard Medical School, Harvard University, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jianren Mao

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hung, L., Wang, J. (2020). Regional Anesthesia in Patients with Spine Pain. In: Mao, J. (eds) Spine Pain Care. Springer, Cham. https://doi.org/10.1007/978-3-030-27447-4_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-27447-4_32

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-27446-7

  • Online ISBN: 978-3-030-27447-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation