Comparison of the Outcomes between General Anaesthesia versus Combined Epidural and General Anaesthesia in Elective Lumbar Spine Surgery: A Randomised Control Study

Introduction: The choice of anaesthesia technique in elective lumbar spine surgery significantly influences perioperative outcomes. While General Anaesthesia (GA) remains the standard approach for lumbar spine surgery, Combined Epidural and General Anaesthesia (CEGA) has gained attention for its potential benefits. Aim: To compare intraoperative and postoperative outcomes of GA versus CEGA in patients undergoing elective lumbar spine surgery. Materials and Methods: This randomised controlled trial was conducted in the Department of Anaesthesiology at a tertiary care centre, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre in Vijayapura, Karnataka, India, on 64 patients of American Society of Anesthesiologists (ASA) grade I and II scheduled for elective lumbar spine surgery from December 2023 to November 2024. Participants were randomly assigned to receive either GA (Group A) alone or CEGA (Group B). The parameters observed included intraoperative vitals, isoflurane requirement, total blood loss during the surgery, and postoperative parameters such as vitals, pain assessed by Visual Analogue Scale (VAS), the rescue analgesic used, and intraoperative and postoperative complications. The Chi-square test was used for data comparison between the groups. Results: The mean ages were 40.34±11.05 years in Group A and 43.13±10.80 years in Group B. Preliminary results indicate that patients in the CEGA group experienced better intraoperative haemodynamic stability than those in the GA group. The inhalational anaesthetic requirement in CEGA (0.388±0.178) was significantly lower than in the GA group (0.782±0.278) (p<0.05). Intraoperative blood loss was higher in GA (387.5±101.6 mL) than in CEGA (138.75±37.22 mL) (p<0.05). In the postoperative period, the VAS score was higher in the GA group (4.43±0.58) than in the CEGA group (3.32±0.63) (p<0.05), and the time to first rescue analgesic requirement was significantly longer in the CEGA group (7.50±1.27 h) (p<0.05). Conclusion: The use of CEGA in elective lumbar spine surgery appears to offer significant advantages over GA alone in terms of intraoperative isoflurane use, blood loss, and postoperative pain management, suggesting that CEGA may be the preferable anaesthetic technique for lumbar spine surgery. Further research with a larger sample size is recommended to validate these results.