[Spinal anesthesia for disk herniation and lumbar laminectomy. Apropos of 77 cases]

Abstract

77 spinal anaesthesias were performed over a 9-month period for surgical cure of herniated discs or lumbar laminectomy in knee-chest posture. Operating conditions were good or excellent in 66 patients (85.7%). Better results were obtained with lidocaine 5% than with bupivacaine 0.5% (both with fentanyl). Nine partial or total failures were recorded, eight of which in patients who underwent a preoperative radiculography and whose spinal anaesthesia was performed with bupivacaine. A likely explanation of these failures might be a leakage of local anaesthetic into the epidural space distended by radiopaque material. No intra or postoperative complications other than six transient hypotensions occurred. Despite of certain advantages, spinal anaesthesia cannot be recommended in all cases, particularly in patients at risk or if surgical time might be protracted. On the other way, ever possible failure obliges to inform preoperatively the patients that general anaesthesia cannot be excluded.