Background

Whilst general anaesthesia is commonly used to undertake spine surgery, the use of neuraxial and peripheral regional anaesthesia techniques for intraoperative and postoperative analgesia is an evolving practice. Variations in practice have meant that it is difficult to know which modalities achieve optimal outcomes for patients undergoing spinal surgery. Our objective was to identify available evidence on the use of regional and neuraxial anaesthesia techniques for adult patients undergoing spinal surgery.

Methods

This study was conducted using a framework for scoping reviews. This included a search of six databases searching for articles published since January 1980. We included studies that involved adult patients undergoing spinal surgery with regional or neuraxial techniques used as the primary anaesthesia method or as part of an analgesic strategy.

Results

Seventy-eight articles were selected for final review. All original papers were included, including case reports, case series, clinical trials, or conference publications. We found that general anaesthesia remains the most common anaesthesia technique for this patient cohort. However, regional anaesthesia, especially non-neuraxial techniques such as fascial plane blocks, is an emerging practice and may have a role in terms of improving postoperative pain relief, quality of recovery, and patient satisfaction. In comparison with neuraxial techniques, the popularity of fascial plane blocks for spinal surgery has significantly increased since 2017.

Conclusions

Regional and neuraxial anaesthesia techniques have been used both to provide analgesia and anaesthesia for patients undergoing spinal surgery. Outcome metrics for the success of these techniques vary widely and more frequently use physiological outcome metrics more than patient-centred ones.

中文翻译：

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脊柱手术的区域和椎管内麻醉技术：范围审查

背景

虽然全身麻醉通常用于进行脊柱手术，但使用椎管内和外周区域麻醉技术进行术中和术后镇痛是一种不断发展的实践。实践中的变化意味着很难知道哪种方式可以为接受脊柱手术的患者实现最佳结果。我们的目标是确定在接受脊柱手术的成年患者中使用区域和椎管内麻醉技术的现有证据。

方法

这项研究是使用范围审查框架进行的。这包括搜索六个数据库，搜索自 1980 年 1 月以来发表的文章。我们纳入的研究涉及接受脊柱手术的成年患者，这些患者使用区域或椎管内技术作为主要麻醉方法或作为镇痛策略的一部分。

结果

选择了 78 篇文章进行最终审查。包括所有原始论文，包括病例报告、病例系列、临床试验或会议出版物。我们发现全身麻醉仍然是该患者队列中最常见的麻醉技术。然而，局部麻醉，尤其是筋膜平面阻滞等非椎管内麻醉技术，是一种新兴的实践，可能在改善术后疼痛缓解、恢复质量和患者满意度方面发挥作用。与椎管内技术相比，自 2017 年以来，用于脊柱手术的筋膜平面阻滞的普及率显着增加。

结论

区域和椎管内麻醉技术已被用于为接受脊柱手术的患者提供镇痛和麻醉。这些技术成功的结果指标差异很大，并且更频繁地使用生理结果指标，而不是以患者为中心的指标。