Comparison of intra‑operative and postoperative outcomes after general versus spinal anaesthesia in lumbar spine surgeries: A prospective comparative study

Abstract

Objective: To compare intraoperative blood loss and early postoperative outcomes in elective lumbar spine surgery under spinal anaesthesia (SA) versus general anaesthesia (GA).

Methods: This prospective comparative study enrolled 60 adults (ASA I–II) undergoing one- or two-level transpedicular lumbar stabilisation in 2022. Patients were allocated to GA (n=30) or SA (n=30) based on anaesthesiologist-surgeon consensus. Mean arterial pressure was maintained at 60–80 mmHg. The primary outcome was intraoperative blood loss (Moore method). Secondary outcomes included haemodynamic changes, postoperative nausea and vomiting (PONV), analgesia, satisfaction, and complications.

Results: Groups were comparable at baseline. Surgery duration was similar. Intraoperative blood loss was significantly higher with GA (p<0.05). Mean heart-rate change from baseline was greater with GA (7±2 vs 3±1 bpm; p=0.039), as was haemoglobin decline (8.4% vs 3.6%; p=0.018). Complication rates and PONV were similar. Surgeon satisfaction (100.0% vs 83.3%; p=0.031) and patient satisfaction (93.3% vs 73.3%; p=0.041) favoured SA. PACU analgesia was comparable, but at 24 hours, eight GA patients required additional analgesia versus none in the SA group (p=0.003).

Conclusion: Spinal anaesthesia was associated with significantly lower intraoperative blood loss, better haemodynamic stability, higher satisfaction, and reduced 24-hour analgesic requirements compared to GA, with mean arterial pressure controlled. SA appears to be a feasible alternative for selected lumbar procedures; larger randomised trials are warranted.