Abstract
Abstract
INTRODUCTION
Enhanced Recovery After Surgery (ERAS) protocols were developed to alleviate the stress response following surgery, thus promoting recovery. Although widely accepted in other specialties, “fast track” surgical approaches are not currently implemented in spine surgery. In this abstract, we tailored some of these principles to minimally invasive spine surgery for the first time.
METHODS
A retrospective review of 94 consecutive patients underwent lumbar fusion with endoscopic decompression, expandable cage, percutaneous pedicle screws, and long-acting depoform bupivacaine under conscious sedation. The comparison cohort of 81 patients underwent a similar procedure under general endotracheal anesthesia (GA) without the use of endoscope.
RESULTS
Groups were not statistically different for age (P = .028), gender (P = .12), and 6-mo fusion rates (100%). Length of stay (median 0 d vs 4 d; P < 10–6), EBL (166 mL vs 24 mL), and operative time (99 ± 3 min vs 175 ± 5 min; P < 10–6) were reduced in the sedation group, in addition to induction time. Mean MAPs were statistically significant (P = .00001) requiring lower doses of pressors (P = .06) and lower crystalloids and colloid administration (P = .000016). Dexmedetomidine and fentanyl equivalent doses were lower in the sedation group but only the latter was significant (P = .000026). Three sedation patients were converted to GA due to vomiting (n = 2) and lack of tolerance (n = 1); no complications resulted.
CONCLUSION
Although endoscopy has aided in lesser tissue disruption, reduced EBL, and operative time, several other factors seemed to play a substantial role toward fast track recovery, resulting in sedation patients experiencing less hypotension, receiving fewer vasopressors, fluids, and opioids, and demonstrating reduced length of stay. This is the largest series till date using ERAS principles for spine surgery.
