Our Summary

This study aimed to understand how French anesthesiologists use spinal anesthesia in both inpatient and outpatient settings. A survey was sent to members of the French Association of Anaesthetists who work with regional anesthesia. The survey asked about how they perform spinal anesthesia, including the type of needle and local anesthetic they use, and how they typically handle five particular kinds of surgeries that could be done on an outpatient basis.

The results, based on 703 responses, showed that the majority of anesthesiologists usually perform spinal anesthesia with the patient sitting up and by using a specific type of needle. Ultrasound was used in about a quarter of the cases, often due to obesity or spinal abnormalities. For the five types of surgeries mentioned, spinal anesthesia was typically suggested for about 30-50% of cases.

The most commonly used local anesthetic was bupivacaine. The main reasons anesthesiologists would choose a different type of anesthesia were concerns about delays in the patient being ready to leave the hospital, the possibility of urinary retention, the length of the operation, and the surgeon’s preference. The study also noted that new local anesthetics are starting to be used in outpatient spinal anesthesia because they work well in this setting. This research will help assess future changes in how spinal anesthesia is practiced.

FAQs

  1. What is the most commonly used local anesthetic in spinal anesthesia by French anesthesiologists?
  2. What are the main reasons anesthesiologists would choose a different type of anesthesia other than spinal anesthesia?
  3. How often is ultrasound used in performing spinal anesthesia and under what circumstances is it typically used?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to follow all pre-operative instructions provided by the medical team, such as fasting before surgery and avoiding certain medications. It is important to communicate openly with your healthcare providers about any concerns or questions you may have, and to follow post-operative instructions carefully to promote a successful recovery. Additionally, engaging in physical therapy and maintaining a healthy lifestyle can help support long-term spinal health following surgery.

Suitable For

Patients who are typically recommended for spinal surgery include those with disc herniation, spinal stenosis, spondylolisthesis, spinal deformities, spinal tumors, and spinal fractures. These conditions can cause severe pain, neurological symptoms, and functional impairment that may not respond to conservative treatments such as physical therapy, medications, and injections. Spinal surgery may be recommended when conservative treatments have failed to provide relief or when there is evidence of nerve compression or spinal instability that requires surgical intervention. Additionally, patients with progressive neurological deficits, such as weakness, numbness, or bladder and bowel dysfunction, may also be candidates for spinal surgery to prevent further nerve damage and improve their quality of life. Ultimately, the decision to undergo spinal surgery is made on a case-by-case basis after a thorough evaluation by a spine specialist, taking into consideration the patient’s symptoms, medical history, imaging studies, and overall health status.

Timeline

Before spinal surgery, a patient will typically undergo a series of consultations with their surgeon and anesthesiologist to discuss the procedure, potential risks and benefits, and to determine the best course of action for their specific condition. They may also undergo preoperative testing and imaging to ensure they are healthy enough for surgery.

On the day of the surgery, the patient will be admitted to the hospital or surgical center and prepared for the procedure. In the case of spinal surgery, the patient may receive spinal anesthesia, which involves injecting a local anesthetic into the space surrounding the spinal cord to numb the lower half of the body. This is done while the patient is sitting up or lying on their side, and typically takes about 10-15 minutes to take effect.

After the surgery, the patient will be monitored closely in the recovery room for a few hours to ensure there are no complications. They may experience some pain and discomfort at the surgical site, which can be managed with medication. The patient will be given instructions on how to care for themselves at home, including how to manage pain, when to follow up with their surgeon, and any restrictions on activities.

In the days and weeks following spinal surgery, the patient will gradually resume normal activities as they recover. Physical therapy may be recommended to help strengthen the muscles surrounding the spine and improve mobility. It can take several weeks to months to fully recover from spinal surgery, depending on the type of procedure performed and the individual patient’s healing process. Regular follow-up appointments with the surgeon will be scheduled to monitor progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal surgery include:

  1. What type of spinal anesthesia will be used for my surgery?
  2. What type of needle will be used for the spinal anesthesia?
  3. What local anesthetic will be used for the spinal anesthesia?
  4. How will the spinal anesthesia be administered (e.g. sitting up, lying down)?
  5. What are the potential risks and complications associated with spinal anesthesia?
  6. How will the anesthesia affect my recovery and post-operative pain management?
  7. Will I be able to go home the same day after the surgery?
  8. What factors would make me a better candidate for spinal anesthesia versus other types of anesthesia?
  9. Are there any alternative anesthesia options available for my surgery?
  10. How experienced is the anesthesiologist in performing spinal anesthesia for this type of surgery?

Reference

Authors: Fuzier R, Aveline C, Zetlaoui P, Choquet O, Bouaziz H; members of the i-ALR Association. Journal: Anaesth Crit Care Pain Med. 2018 Jun;37(3):239-244. doi: 10.1016/j.accpm.2016.12.002. Epub 2016 Dec 19. PMID: 28007520