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Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

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Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

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Combining Awake Anesthesia with Minimal Invasive Surgery Optimizes Intraoperative Surgical Spinal Cord Stimulation

Philippe Rigoard^1,2,3, Amine Ounajim¹, Lisa Goudman^4,5,6

¹PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France.

Journal of Clinical Medicine

|October 14, 2022

Summary

Awake surgery for spinal cord stimulation (SCS) placement in chronic pain patients significantly improves pain coverage and intensity compared to general anesthesia. This approach enhances outcomes and quality of life for persistent spinal pain syndrome-type 2.

Keywords:

FBSS MAST (for minimal access spine technologies)PSPS SCS SCS implantation TCIVA (for target controlled intra-venous anesthesia)anesthesia chronic pain composite score hypnosis neuropathic pain pain mapping quality of life surgical lead

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Area of Science:

Neurosurgery
Pain Management
Anesthesiology

Background:

Spinal cord stimulation (SCS) is a validated treatment for chronic refractory neuropathic pain in persistent spinal pain syndrome-type 2 (PSPS-T2).
Traditional SCS lead placement uses general anesthesia due to surgical invasiveness.
Awake anesthesia (AA), utilizing target-controlled intravenous anesthesia (TCIVA), offers potential for optimized lead placement via intraoperative patient feedback.

Purpose of the Study:

To evaluate SCS lead performance using an intraoperative quantitative mapping tool.
To compare outcomes of minimal invasive surgery under AA (MISAA) versus general anesthesia (MISGA) and laminectomy under general anesthesia (LGA).
To assess secondary outcomes including pain relief, functional improvement, and quality of life.

Main Methods:

Prospective multicenter study (ESTIMET) analyzing data from 115 PSPS-T2 patients.
Comparison of three surgical groups: MISAA, MISGA, and LGA.
Intraoperative objective quantitative mapping for SCS lead performance and composite score for secondary outcomes.

Main Results:

MISAA demonstrated significantly better patient pain coverage (65% vs. 34-62%) and pain intensity reduction (65% vs. 35-40%) compared to general anesthesia groups.
Improved pain surface coverage was observed in the MISAA group (50-76% vs. 50-61%).
Secondary outcomes, including quality of life, functional disability, and depression, were significantly improved with MISAA.

Conclusions:

Awake surgery for SCS lead placement in PSPS-T2 patients shows superior performance over general anesthesia.
MISAA, potentially enhanced with intraoperative hypnosis, offers a promising personalized approach for SCS implantation.
This technique could be proposed in specialized neuromodulation centers for eligible PSPS-T2 patients.