Comparison of spinal , epidural and general anesthesia methods for lumbar disc surgery

The purpose of our study was to compare and to state the effects of epidural, spinal and general anesthesia on perioperative hemodynamic parameters, side effects, patient convenience, discharge criteria and analgesic requirement in patients undergoing elective lumbar discectomy. 60 ASA class I-II patients were randomly assigned in 3 groups. Epidural anesthesia was performed in sitting position using 18 G Tuohy needle and 20-25 ml of bupivacaine 0,5 %. Spinal anesthesia was performed in sitting position using 25 G needle and heavy bupivacaine 0,5 %. General anesthesia was inducted with propofol 2-3 mg/kg, rocuronium 0,6 mg/kg and fentanyl 1 mcg/kg and maintained with 50% oxygen and 50% medical air of 4 l/min total flow rate and sevoflurane of 1-1,5 MAC. Intraoperative all patients were in prone position. Blood pressure, heart rate, SpO2, duration of surgery, VAS scores, postoperative analgesic procedure, side effects and complications were recorded. Age, gender, weight, height, BMI, ASA class, basal VAS scores, blood pressures, heart rates and SpO2 values were similar between 3 groups. Systolic pressure values measured intraoperatively and postoperatively in PACU were significantly lower than basal values (p<0,05). There was no significant difference in occurence of bradycardia, tachycardia, hypotension, bronchospasm, hemorrhagia between groups. Intraoperative atropine and ephedrine demands showed no significant difference. The number of hypertensive patients in general anesthesia group was significantly higher than other two groups. In all patients in spinal and epidural groups were occupied a satisfying block level. There was no difference in intraoperative opioid demand but VAS scores on the end of surgery and on in- and outgoing PACU were significantly lower in epidural anesthesia group (p<0,05). In patient convenience there was no significant difference between groups. There was no significant difference in duration of anesthesia, duration of surgery and duration of stay in PACU between groups. Concurrently there was no significant difference between groups in postoperative nausea, vomiting, urinary retention, additional opioid demand, mobilisation time and discharge time. Central nervous system toxicity of local anesthetic occurred in one patient in epidural anesthesia group. We concluded that regional anesthesia technics are effective and safe alternatives to general anesthesia in lumbar disc operations as hemodynamic parameters, patient convenience and satisfaction are similar between epidural, spinal and general anesthesia groups. We recommend more extensively performance of spinal and epidural anesthesia in lumbar disc surgery as in many other operations.