Spinal surgery has traditionally been performed under general anaesthesia (GA), largely because of concerns regarding airway access, patient positioning, procedure duration, and the potential need for intraoperative neurological assessment. However, growing evidence suggests that spinal anaesthesia (SA) may be a viable alternative for selected spinal procedures, offering several perioperative advantages without compromising patient safety. Recent literature indicates that SA is increasingly being adopted for lumbar decompression, microdiscectomy and selected fusion procedures, prompting renewed discussion regarding its role within contemporary spinal practice.\u00b9<\/p>\n\n\n\n
A 2025 review published in Current Anesthesiology Reports<\/em> provides a comprehensive overview of the evidence supporting neuraxial anaesthesia for spine surgery and offers practical recommendations for implementation.\u00b9 The review highlights both the opportunities and limitations of this evolving approach, emphasising that careful patient selection remains fundamental to success.<\/p>\n\n\n\n Although GA remains the predominant anaesthetic technique for spinal operations worldwide, several studies have demonstrated that SA may confer meaningful benefits in appropriately selected patients. The resurgence of interest reflects broader perioperative trends towards enhanced recovery pathways, opioid-sparing strategies and optimisation of healthcare resources.\u00b9,\u00b2<\/p>\n\n\n\n Neuraxial anaesthesia produces dense sensory and motor blockade while maintaining spontaneous ventilation and avoiding many of the physiological effects associated with general anaesthesia. As a result, investigators have examined whether SA can improve surgical conditions and postoperative recovery in spine surgery.\u00b9,\u00b3<\/p>\n\n\n\n Reduced intraoperative blood loss<\/strong><\/p>\n\n\n\n One of the most consistently reported advantages of SA is reduced intraoperative blood loss. The sympathectomy associated with neuraxial blockade can lower venous pressure within the operative field, potentially improving surgical visibility and reducing bleeding.\u00b9<\/p>\n\n\n\n Several comparative studies reviewed by Buren and Cil found lower estimated blood loss in patients receiving SA compared with GA for lumbar spine procedures.\u00b9 Similar findings have been reported in broader analyses of spinal surgery, where anaesthetic technique was identified as one of several factors influencing blood loss and transfusion requirements.\u2074<\/p>\n\n\n\n Reduced bleeding may have practical implications beyond transfusion avoidance. Improved visualisation of anatomical structures can facilitate surgical precision and potentially shorten operative time, although this relationship remains influenced by procedural complexity and surgeon experience.\u00b9<\/p>\n\n\n\n Improved early postoperative analgesia<\/strong><\/p>\n\n\n\n Evidence supporting superior immediate postoperative pain control following SA is particularly compelling. Because local anaesthetics and adjuncts remain active into the early recovery period, patients frequently report lower pain scores and reduced opioid requirements following surgery.\u00b9<\/p>\n\n\n\n Better postoperative analgesia aligns with wider evidence demonstrating the value of neuraxial techniques in improving patient comfort and reducing opioid-related adverse effects.\u00b2 The potential reduction in opioid consumption may be especially relevant in spinal surgery, where postoperative pain can be substantial and opioid stewardship remains a clinical priority.<\/p>\n\n\n\n Faster operating theatre turnover<\/strong><\/p>\n\n\n\n The 2025 review also highlights evidence suggesting faster operating room egress and recovery following SA.\u00b9 Avoidance of induction and emergence from GA, combined with reduced rates of airway-related interventions, may contribute to more efficient theatre utilisation.<\/p>\n\n\n\n For healthcare systems facing increasing pressure on surgical capacity, even modest improvements in perioperative workflow may prove valuable. However, institutional benefits are likely to depend on local pathways, case mix and familiarity with neuraxial techniques.\u2075<\/p>\n\n\n\n Despite promising findings, not all proposed benefits are consistently supported by the literature.<\/p>\n\n\n\n Haemodynamic stability<\/strong><\/p>\n\n\n\n Historically, concerns regarding neuraxial anaesthesia have centred on hypotension resulting from sympathetic blockade. While some studies report favourable haemodynamic profiles during spinal surgery under SA, others have demonstrated no significant differences compared with GA.\u00b9<\/p>\n\n\n\n Consequently, the current evidence does not definitively establish SA as superior for haemodynamic stability. Instead, the literature suggests that outcomes are highly dependent upon patient characteristics, fluid management strategies and the extent of sympathetic blockade achieved.\u00b9<\/p>\n\n\n\n Length of stay and postoperative nausea<\/strong><\/p>\n\n\n\n The relationship between SA and hospital length of stay remains less clear. Some investigations report earlier discharge, particularly in minimally invasive lumbar procedures, whereas others demonstrate little difference when compared with modern GA protocols.\u00b9<\/p>\n\n\n\n Similarly, findings regarding postoperative nausea and vomiting are inconsistent. Improvements have been observed in some patient populations, but results have not been sufficiently uniform to support definitive conclusions.\u00b9<\/p>\n\n\n\n A recurring theme throughout the reviewed evidence is the importance of selecting appropriate candidates.<\/p>\n\n\n\n The ideal patient for SA is generally one undergoing a lower-complexity lumbar procedure of predictable duration.\u00b9<\/strong><\/p>\n\n\n\n Factors favouring consideration of SA may include:<\/p>\n\n\n\n Conversely, extensive multilevel surgery, anticipated prolonged operating times, severe spinal deformity and patients unable to tolerate awake positioning may favour the continued use of GA.\u00b9<\/p>\n\n\n\n Patient counselling is equally important. Successful implementation requires clear preoperative discussion regarding intraoperative expectations, positioning requirements and contingency plans should conversion to GA become necessary.<\/p>\n\n\n\n While the potential benefits of spinal anaesthesia (SA) are increasingly recognised, successful implementation depends on careful planning and appropriate case selection. The review highlights several practical considerations that can help clinicians integrate SA safely and effectively into spinal surgery pathways.\u00b9<\/p>\n\n\n\n Choice of intrathecal medication<\/strong><\/p>\n\n\n\n Local anaesthetic selection should be tailored to the anticipated duration of surgery. Hyperbaric and isobaric preparations may each have advantages depending on positioning and procedural requirements. Adjuncts can be used to prolong block duration and optimise analgesia, although clinicians must balance potential benefits against adverse effects.\u00b9<\/p>\n\n\n\n Airway planning<\/strong><\/p>\n\n\n\n Even when surgery is intended to proceed under SA, airway management planning remains essential. Prone positioning can complicate emergency airway access, making preparation and contingency strategies particularly important.\u00b9<\/p>\n\n\n\n Clinicians should ensure:<\/p>\n\n\n\n Troubleshooting and conversion<\/strong><\/p>\n\n\n\n Block inadequacy, patient discomfort or unexpectedly prolonged surgical duration may necessitate conversion to GA. The authors emphasise the need for advance planning rather than viewing conversion as a failure of technique.\u00b9<\/p>\n\n\n\n The evidence base supporting SA for spine surgery continues to expand. Current research suggests that, for selected patients and procedures, SA can reduce blood loss, improve early postoperative analgesia and potentially enhance perioperative efficiency.\u00b9,\u00b3<\/p>\n\n\n\n However, the literature also highlights important limitations. Benefits related to haemodynamic stability, postoperative nausea and hospital length of stay remain inconsistent, and wider adoption will require continued refinement of selection criteria and procedural protocols.\u00b9<\/p>\n\n\n\n Rather than replacing GA, SA appears increasingly positioned as an additional tool within the anaesthetist’s armamentarium. As experience grows and evidence accumulates, neuraxial anaesthesia may become an increasingly routine option for appropriately selected spinal surgery patients.<\/p>\n\n\n\n Spinal surgery has traditionally been performed under general anaesthesia (GA), largely because of concerns regarding airway access, patient positioning, procedure duration, and the potential need for intraoperative neurological assessment. However, growing evidence suggests that spinal anaesthesia (SA) may be a viable alternative for selected spinal procedures, offering several perioperative advantages without compromising patient safety. Recent […]<\/p>\n","protected":false},"author":4,"featured_media":53413,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[16],"tags":[124,123],"class_list":["post-53890","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anaesthesia-and-intensive-care","tag-anaesthesia","tag-spinal"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53890","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/comments?post=53890"}],"version-history":[{"count":1,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53890\/revisions"}],"predecessor-version":[{"id":53891,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53890\/revisions\/53891"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media\/53413"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media?parent=53890"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/categories?post=53890"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/tags?post=53890"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Why reconsider spinal anaesthesia for spine surgery?<\/h2>\n\n\n\n
Evidence for perioperative benefits<\/h2>\n\n\n\n
Areas where evidence remains mixed<\/h2>\n\n\n\n
Patient selection remains critical<\/h2>\n\n\n\n
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Practical considerations for anaesthesia providers<\/h2>\n\n\n\n
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Looking ahead<\/h2>\n\n\n\n
References<\/h3>\n\n\n\n
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