Enhanced Recovery after lumbar laminectomy using combined epidural and general anesthesia with tolerable endotracheal tube: Randomized controlled study.

Background: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative management pathways that can facilitate early recovery. This prospective randomized controlled study was to investigate if combining single shot epidural blockade and general anesthesia (CEGA) using a tolerable endotracheal tube (TET), can enhance recovery after lumbar laminectomy. 40 patients were included in the study and allocated into one of two groups (20 patients each); group I (general anesthesia (GA) group) and group II (CEGA using TET group) in which patients received an epidural single shot bupivacaine 15 ml of 0.25% followed by a standard general anesthetic technique using TET through its side small channel, a dose of 2mg/kg, lidocaine 2% was instilled immediately after intubation and repeated 10 minutes before anesthetic discontinuation. The primary objectives were post-anesthesia care unit (PACU) stay, time to tracheal extubation, and hospital stay. Results: PACU stay was significantly shorter in in CEGA with the TET group (median 10 IQR 8.25- 14.25 mins) compared to GA group (median 24.5 IQR 18.5-31.5) (p <0.001) and time to extubation was also significantly shorter in CEGA with the TET group (median 12 IQR 10- 14.75) compared to GA group (median 15.5 IQR 15- 18) (p <0.001) with no difference regarding hospital stay (p 0.341).Conclusions: CEGA, including a single shot epidural bupivacaine 0.25% and laryngeal lidocaine instillation through TET can reduce time to tracheal extubation and PACU stay and the incidence of peri-extubation cough with no effect on the time to home readiness after lumbar laminectomy.