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Abstract Background Lumbar disc herniation is seen in 5–15% of patients with lumbar back pain and is the most common spine disorder demanding surgical correction. Spinal surgery is one of the most effective management for these patients. However, current surgical techniques still present complications such as chronic pain in 10–40% of all patients who underwent lumbar surgery, which has a significant impact on patients’ quality of life. Research studies have shown that transcutaneous electrical acupoint stimulation (TEAS) may reduce the cumulative dosage of intraoperative anesthetics as well as postoperative pain medications in these patients. Objective To investigate the effect of pTEAS on pain management and clinical outcome in major spinal surgery patients. Methods We conducted a prospective, randomized, double-blind study to verify the effect of pTEAS in improving pain management and clinical outcome after major spinal surgery. Patients (n = 90) who underwent posterior lumbar fusion surgery were randomized into two groups: pTEAS, (n = 45) and Control (n = 45). The pTEAS group received stimulation on acupoints Zusanli (ST.36), Sanyinjiao (SP.6), Taichong (LR.3), and Neiguan (PC.6). The Control group received the same electrode placement but with no electrical output. Postoperative pain scores, intraoperative outcome, perioperative hemodynamics, postoperative nausea and vomiting (PONV), and dizziness were recorded. Results Intraoperative outcomes of pTEAS group compared with Control: consumption of remifentanil was significantly lower (P

Background: Lumbar disc herniation is seen in 5–15% of patients with lumbar back pain and is the most common spine disorder demanding surgical correction. Spinal surgery is one of the most effective management for these patients. However, current surgical techniques still present complications such as chronic pain in 10–40% of all patients who underwent lumbar surgery, which has a significant impact on patients' quality of life. Research studies have shown that transcutaneous electrical acupoint stimulation (TEAS) may reduce the cumulative dosage of intraoperative anesthetics as well as postoperative pain medications in these patients. Objective: To investigate the effect of pTEAS on pain management and clinical outcome in major spinal surgery patients. Methods: We conducted a prospective, randomized, double-blind study to verify the effect of pTEAS in improving pain management and clinical outcome after major spinal surgery. Patients (n = 90) who underwent posterior lumbar fusion surgery were randomized into two groups: pTEAS, (n = 45) and Control (n = 45). The pTEAS group received stimulation on acupoints Zusanli (ST.36), Sanyinjiao (SP.6), Taichong (LR.3), and Neiguan (PC.6). The Control group received the same electrode placement but with no electrical output. Postoperative pain scores, intraoperative outcome, perioperative hemodynamics, postoperative nausea and vomiting (PONV), and dizziness were recorded. Results: Intraoperative outcomes of pTEAS group compared with Control: consumption of remifentanil was significantly lower (P < 0.05); heart rate was significantly lower at the end of the operation and after tracheal extubation (P < 0.05); and there was lesser blood loss (P < 0.05). Postoperative outcomes: lower pain visual analogue scale (VAS) score during the first two days after surgery (P < 0.05); and a significantly lower rate of PONV (on postoperative Day-5) and dizziness (on postoperative Day-1 and Day-5) (P < 0.05). Conclusion: pTEAS could manage pain effectively and improve clinical outcomes. It could be used as a complementary technique for short-term pain management, especially in patients undergoing major surgeries. Trial registration: ChiCTR1800014634, retrospectively registered on 25/01/2018. http://medresman.org/uc/projectsh/projectedit.aspx?proj=183 [ABSTRACT FROM AUTHOR]

Latar Belakang dan Tujuan: Dexmedetomidine (DEX) suatu agonis α2, telah banyak digunakan untuk mengendalikan respon stress pembedahan melalui penekanan respon simpatis dan endokrin. Studi ini bertujuan untuk menganalisis efek penambahan dexmedetomidine terhadap kadar kortisol, nadi, tekanan arteri rerata, kebutuhan penggunaan fentanyl dan isoflurane pada operasi tulang belakang. Metode: Sebuah studi randomisasi terkontrol tersamar ganda dilakukan pada pasien yang menjalani operasi besar tulang belakang elektif di RSUD Dr. Soetomo, Surabaya. Nadi, tekanan arteri rerata, kebutuhan fentanyl dan isoflurane serta perubahan kadar kortisol pre dan post-operatif dibandingkan antara pasien yang memperoleh dexmedetomidine (DEX) dan placebo (SAL). Hasil: Nadi dan tekanan arteri rerata lebih stabil pada kelompok DEX pada saat intubasi, prone positioning dan insisi. Perubahan kadar kortisol pada kelompok DEX (9,9±5,2 mcg/dl) lebih rendah dibanding kelompok SAL (11.7±8.4 mcg/dl) namun tidak berbeda bermakna secara statistik (p=0.88). Penggunaan fentanyl dan isofluran pada kelompok DEX dapat dikurangi masing-masing 50% (p=0,00) dan 30% (p=0,00). Kecepatan pulih sadar kelompok DEX lebih cepat. (p=0,001) Simpulan: Hemodinamik yang stabil, berkurangnya penggunaan opioid dan anestesi inhalasi serta proses pulih sadar yang lebih cepat pada kelompok DEX mendukung penggunaan dexmedetomidine dalam operasi besar tulang belakang. Analysis of Dexmedetomidine Addition in Elective Major Spinal Surgery in RSUD Dr. Soetomo Abstract Background and Objective: Dexmedetomidine (DEX) an α2 agonist, is widely used to control stress response during surgery through inhibition of sympathetic and endocrine response. This study aims to analyze the effect of dexmedetomidine addition towards blood cortisol level, pulse rate, mean arterial pressure, and fentanyl and isoflurane use during major spinal surgery. Method: A randomized doubleblind controlled study was conducted on twenty patients undergoing major spinal surgery in RSUD dr. Soetomo, Surabaya. Pulse rate, mean arterial pressure, fentanyl and isoflurane used, and plasma cortisol changes were compared between patients receiving dexmedetomidine (DEX) and placebo (SAL). Results: Pulse rate and mean arterial pressure was more stable in DEX group during intubation, prone positioning and incision. Changes in cortisol level in DEX group (9.9±5.2 mcg/dl) was lower, but not statistically significant fromSAL group (11.7±8.4 mcg/dl,p=0.88). Fentanyl and isoflurane use in DEX group was reduced 50% (p=0.00) and 30% (p=0.00) respectively. Recovery time in DEX group was faster (p=0.001). Conclusion: Hemodinamik stability, reduced opioid and inhalational anesthesia use, and faster anesthesia recovery time supports dexmedetomidine as anadjunct in general anesthesia in major spinal surgery.

This article examines the relevance of applying the Enhanced Recovery after Surgery (ERAS) approach to patients undergoing major spinal surgery. The history of ERAS, details of the components of the approach and the underlying rationale are explained. Evidence on outcomes achieved by using the ERAS approach in other orthopaedic and complex surgical procedures is then outlined. Data on major spinal surgery rates and current practice are reviewed; the rationale for using ERAS in major spinal surgery is discussed, and potential challenges to its adoption are acknowledged. A thorough literature search is then undertaken to examine the use of ERAS pathways in major spinal surgery, and the results are presented. The article then reviews the evidence to support the application of individual ERAS components such as patient education, multimodal pain management, surgical approach, blood loss, nutrition and physiotherapy in major spinal surgery, and discusses the need for further robust research to be undertaken. The article concludes that given the rising costs of surgery and levels of patient dissatisfaction, an ERAS pathway that focuses on optimising clinical procedures by adopting evidence-based practice and improving logistics should enable major spinal surgery patients to recover more quickly with lower rates of morbidity and improved longer-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Recent years have been characterized by a great technological and clinical development in spine surgery. In particular, enhanced recovery after surgery (ERAS) programs, started to gain interest also in this surgical field. Here we tried to analyse the current state of art of ERAS technique in spine surgery., Material and Method: A systematic review of the literature has been performed in order to find all the possible inclusions. Using the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, Medline databases was conducted to identify all full-text articles in the English-language literature describing the use of ERAS programs or techniques for spine surgery in adult patients., Results: Out of the 827 studies found, only 21 met the inclusion criteria has been retained to be included in the present study. The most frequently benefits of ERAS protocols were shorter hospitalisations (n=15), and decreased complication rates (n=8) lower postoperative pain scores (n=4). These benefits were seen in the 3 main categories considered: lumbar spine surgeries, surgeries for correction of scoliosis or deformity, and surgeries of the cervical spine., Conclusion: There are an arising amount of data showing that the use of ERAS programs could be helpful in reducing the days of hospitalizations and the number of complications for certain spinal procedures and in a highly selected group of patients. Despite the large interest on the topic; there is an important lack of high level of scientific evidences. Because of that, there is the need to encourage the design and creation of new randomized clinical trials that will validate the present findings., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

OBJECTIVE:: The aim of the study is to investigate the evolution of nutritional parameters after major spinal surgery in patients with idiopathic scoliosis. METHODS:: This retrospective study included 31 patients with a mean age of 18?y, diagnosed with idiopathic scoliosis. The following variables were analyzed: demographic, surgical (type, number of fused segments, duration, and blood loss), nutritional assessment (proteins, albumin, prealbumin, transferrin, lymphocytes, and body mass index), and duration of hospitalization at different time points. Statistical analyses were performed with the SPSS 6.1 software. RESULTS:: Before surgery, nutritional status was normal in all patients. At 24-48?h after surgery, statistically significant decrease with respect to preoperative values was recorded for all the parameters studied: proteins (P<0.001), albumin (P<0.001), prealbumin (P<0.01), transferrin (P<0.001), and lymphocytes (P<0.001). CONCLUSION:: Our results showed a significant postoperative decrease in the nutritional parameters analyzed in a previously well-nourished population considered to be at low risk for nutritional depletion.European Journal of Clinical Nutrition (2005) 59, 720-722. doi:10.1038/sj.ejcn.1602126 Published online 2 March 2005 [ABSTRACT FROM AUTHOR]

Objective: Despite surgical, technological, medical, and anesthetic improvements, patient outcomes following elective neurosurgical procedures can be associated with high morbidity. Enhanced recovery after surgery (ERAS) protocols are multimodal care pathways designed to optimize patient outcomes by addressing pre-, peri-, and post-operative factors. Despite significant data suggesting improved patient outcomes with the adoption of these pathways, development and implementation has been limited in the neurosurgical population., Methods/results: This study protocol was designed to establish the feasibility of a randomized controlled trial to assess the efficacy of implementation of an ERAS protocol on the improvement of clinical and patient reported outcomes and patient satisfaction scores in an elective inpatient spine surgery population. Neurosurgical patients undergoing spinal surgery will be recruited and randomly allocated to one of two treatment arms: ERAS protocol (experimental group) or hospital standard (control group). The experimental group will undergo interventions at the pre-, peri-, and post-operative time points, which are exclusive to this group as compared to the hospital standard group., Conclusions: The present proposal aims to provide supporting data for the application of these specific ERAS components in the spine surgery population and provide rationale/justification of this type of care pathway. This study will help inform the design of a future multi-institutional, randomized controlled trial., Results: of this study will guide further efforts to limit post-operative morbidity in patients undergoing elective spinal surgery and to highlight the impact of ERAS care pathways in improving patient reported outcomes and satisfaction., (Copyright © 2017 Elsevier B.V. All rights reserved.)