Ali Fadhil Al-Emran, defended his Thesis titledComparing the Clinical and Economical Outcomes of Reginal and General Anesthesia for Lumbar Spine Surgery: A Systematic Review


      Lumbar spine surgery can be performed under general or regional anesthesia safely, but there are controversies on clinical outcome and cost benefit of each method. The aim of this systematic review and meta-analysis were to determine advantages of each technique (regional or general anesthesia) for lumbar spine surgery with regard to cost, duration of surgery, duration of post anesthesia care unit, and duration of hospital stay.

We conducted a systematic search for articles comparing regional (RA) versus general anesthesia (GA) for lumbar spine surgery, using three major databases (PubMed, EMBASE, and Google Scholar), without limitation in date and language of publication. We also manually checked the references of all relevant articles to identify missed studies by electronic searching. The last search was performed before sept 2018, the quality of the including articles was assessed by different checklists according to the type of the article STATA (v. 10) was using for performing meta-analysis.

twenty-eight articles included in this meta-analysis. cost data was presented in seven studies and reported a significant decrease in the cost in RA patients compared with GA patients. The Standard Mean Difference (SMD) ( 95% CI ) for cost was 1.64 (1.53 to 1.75); z=29.17; P<0.001; I2=98.9].,    surgical time  data was presented in twenty five  studies and reported  significant  decrease  in the surgery  time in RA patients compared with GA patients, the SMD (95% CI) for surgery  time    was 0.77 (0.71 to -0.84); z=23.9; P<0.001; I2=97.9].While, post anesthesia care unit stay data was presented in sixteen studies and reported significant  increase  in the PACU stay in RA patients compared with GA patients  The (SMD) (95% CI ) for PACU time   was -0.4 (-0.49 to -0.31); z=8.65; P<0.001; I2=99.2].  hospital stay data was presented in eighteen studies and reported significant decrease in the hospital time in RA patients compared with GA patients, The SMD (95% CI) for hospital time was 0.76 (0.68 to 0.84); z=18.81.; P<0.001; I2=98.3].  Eggers and Begges   tests showed no significant publication bias.

This is comprehensive systematic review showed that regional anesthesia has several advantages over general anesthesia with respect to Cost, surgery time, and duration of hospital stay in patient undergoing lumbar spine surgery. While increase in PACU time was observed in in RA patients.



Supervisors: Dr. Z. Hossein Khan, Dr. A. Hajipour

Advisors: Dr. M. Rahimi, Dr. M Maghsoudloo

External Reviewers: Dr. A. Shamsi

Internal Reviewers: Dr. M. Mohammadi, Dr. A. H. Orandi