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

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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.

About the authors

Vadim A. Byvaltsev

Irkutsk State Medical University; Clinical Hospital “RZD-Medicine”

Author for correspondence.
Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101
SPIN-code: 5996-6477
Scopus Author ID: 25421197400
ResearcherId: D-1962-2018

MD, Dr. Sci. (Med.), professor

Russian Federation, Irkutsk; Irkutsk

Aleksei V. Shchegolev

Kirov Military Medical Academy

Email: alekseischegolev@gmail.com
ORCID iD: 0000-0001-6431-439X
SPIN-code: 4107-6860
Scopus Author ID: 7003338841
ResearcherId: J-4326-2013

MD, Dr. Sci. (Med.), professor

Russian Federation, Saint Petersburg

Victorya Yu. Goloborodko

Irkutsk State Medical University; Clinical Hospital “RZD-Medicine”

Email: gra4ova.viky@gmail.com
ORCID iD: 0000-0003-4927-0370
SPIN-code: 7534-8961
Scopus Author ID: 57194019332
ResearcherId: HLW-4125-2023

anesthesiologist

Russian Federation, Irkutsk; Irkutsk

Andrei A. Kalinin

Irkutsk State Medical University; Clinical Hospital “RZD-Medicine”

Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0002-6059-4344
SPIN-code: 9707-8291
Scopus Author ID: 55108587100
ResearcherId: R-7408-2016

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Irkutsk; Irkutsk

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2. Fig. 1. The flow chart characterizing the design of the study. Reasons for exclusion (1): * — injury to the spine and/or spinal cord; ** — tumor of the spine/roots of the spinal cord; *** – inflammatory diseases of the spine. Reasons for exclusion (2): * — the risk of providing neuroanesthetic care is ≤ 8 points. Reasons for exclusion (3): * – primary decompressive or stabilizing interventions; ** — revision interventions; *** — significant osteoporosis; **** — drug allergies; 5* — < 16 MoCA points; 6* — refusal to participate in the study

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3. Fig. 2. Changes in the intensity of local pain syndrome according to VAS in patients in the studied groups

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