From the Guidelines
Yes, a patient can receive a spinal block prior to a laminectomy, as it is a viable anesthetic option for this procedure. A spinal block involves injecting local anesthetic into the subarachnoid space to temporarily block sensation and movement below the injection site. According to the ERAS society recommendations 1, short-acting intravenous drugs can be titrated carefully by the anaesthetist to facilitate the safe administration of epidural or spinal analgesia, which does not significantly affect recovery.
Key Considerations
- The decision to use a spinal block ultimately depends on factors including the specific vertebral levels involved, expected duration of surgery, patient comorbidities, and surgeon preference.
- Patients with severe cardiopulmonary disease or difficult airways may benefit from a spinal block combined with sedation, as it may pose fewer risks compared to general anesthesia.
- The use of anticoagulation therapy, such as warfarin, requires careful management perioperatively, and bridging therapy with low molecular weight heparin (LMWH) may be necessary to minimize the risk of thromboembolic events 1.
Anesthetic Approach
- General anesthesia is typically preferred for laminectomy procedures, as it allows for complete immobility of the patient and surgical site.
- However, a spinal block can be a suitable alternative in certain cases, and its use should be determined on a case-by-case basis, taking into account the individual patient's needs and medical history.
- Patients should discuss anesthetic options with their anesthesiologist during pre-operative consultation to determine the most appropriate approach for their specific situation.
From the FDA Drug Label
In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3 mL of the indicated concentration per dermatome) Caudal and Lumbar Epidural Block As a precaution against the adverse experience sometimes observed following unintentional penetration of the subarachnoid space, a test dose such as 2 to 3 mL of 1. 5% lidocaine hydrochloride should be administered at least 5 minutes prior to injecting the total volume required for a lumbar or caudal epidural block.
Spinal Block Prior to Laminectomy: A spinal block, which is similar to an epidural block, can be administered prior to a laminectomy. The dosage and administration of the spinal block would depend on various factors, including the type and extent of the surgical procedure, the depth of anesthesia required, and the physical condition of the patient.
- Key Considerations:
- The patient should be closely monitored for any adverse reactions.
- A test dose should be administered prior to the total volume required for the block.
- The lowest concentration and smallest dose that will produce the desired result should be given. 2
From the Research
Spinal Block Prior to Laminectomy
- A spinal block can be administered prior to a laminectomy, as evidenced by studies 3, 4 that have investigated the use of spinal anesthesia in lumbar laminectomy surgery.
- The study by 3 found that spinal anesthesia was successful in 85.7% of cases, with good or excellent operating conditions, although it noted that spinal anesthesia cannot be recommended in all cases, particularly in patients at risk or if surgical time might be protracted.
- Another study 4 compared spinal and general anesthesia in lumbar laminectomy surgery and found that spinal anesthesia was as safe and effective as general anesthesia, with potential advantages including shorter anesthesia duration, decreased nausea, and fewer complications.
Types of Anesthesia
- Local anesthesia can also be used for laminectomy surgery, as presented in the case study by 5, which found that local anesthesia can offer a safe and satisfactory alternative in patients who may otherwise be denied surgery.
- Epidural anesthesia has been evaluated for laminectomy lead placement in spinal cord stimulation, with a study by 6 finding it to be a suitable technique that seems to be safe and effective.
- The erector spinae plane block has been used to provide analgesia for various surgeries, but its safety in patients with laminectomy has been questioned, as highlighted in the case report by 7, which presents unique considerations regarding the safety of the ESP block in such patients.