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Impact of Epidural Versus General Anesthesia on Major Lumbar Surgery in Elderly Patients

Study Design: This was a retrospective comparative study. Objective: The main objective of this study was to investigate the effects of epidural anesthesia (EA) versus general anesthesia (GA) in elderly patients undergoing lower lumbar spine fusion surgeries. Summary of Background Data: Lumbar spine surgery can be performed under GA or regional anesthesia. GA is more commonly used in lumbar spine surgery, which renders the patient motionless throughout the procedure and provides a secure airway. Although EA is associated with superior hemodynamic status, reduced duration of operation, less health care cost, and lower rate of surgical complications when compared with GA. Controversy still exists with regard to the optimum choice of anesthesia for major lumbar spine surgery, especially in elderly patients. Materials and Methods: From September 2016 to August 2017, consecutive patients aged 70 years or older who underwent lower lumbar fusion surgery with EA or GA were enrolled in the study. Recorded data for all patients included: age, sex, medical conditions; surgical time, operation procedure, blood loss; intraoperative hypertension and tachycardia; occurrence of nausea, vomiting, delirium, or cardiopulmonary complications. Postoperative pain and satisfaction were also assessed. Results: A total of 89 patients were included. Of these, 42 patients underwent GA and 47 patients underwent EA. The number of patients experiencing hypertension and tachycardia during anesthesia was significantly increased in the GA group when compared with EA. Patients with EA had significantly less delirium, nausea, and vomiting. The average Visual Analog Scale scores were significantly higher in the GA group at 0–8 hours after surgery. Patients underwent EA were more satisfied than patients with GA. Conclusions: There was an association between those who received EA and superior perioperative outcomes. However, some concerns including airway security, operation duration, and obesity, must be carefully evaluated. In addition, it should be noted that this study was retrospective and selection bias may probably exist which may interfere with the results.