Analgesic effect of epidural anesthesia via the intervertebral foramen approach in percutaneous transforaminal endoscopic discectomy: a retrospective study

Abstract

Background Satisfactory intraoperative analgesia is critical for percutaneous transforaminal endoscopic discectomy (PTED). Local anesthesia (LA) and epidural anesthesia (EA) are recommended for PTED. LA alone does not achieve satisfactory pain management during PTED and other analgesics or sedatives are usually needed. Traditional EA, which involves implanting an epidural catheter through the midline or paramedian, has disadvantages such as difficulty in catheterization and increased preoperative preparation time. Rather than performing conventional EA, we injected local anesthetics through the intervertebral foramen during the puncture process, which we termed lumbar transforaminal EA (LTEA), and observed its feasibility and safety. This study aimed to conduct a comprehensive comparison of differences in analgesia between LA and LTEA in patients with PTED. Methods We performed a retrospective analysis of patients who underwent PTED between January 2018 and January 2021. Patients were divided into LA and LTEA groups. Data obtained from the electronic medical records included primary outcomes (visual analog scale [VAS] scores and anesthesia satisfaction rate) and secondary outcomes, including vital signs such as heart rate (HR), mean arterial pressure (MAP), total dosage of fentanyl, operation time, X-ray exposure time, Oswestry Disability Index (ODI) scores, and complications. Results In total, 160 patients (80 in each group) were analyzed in this study. The VAS scores for lumbar and leg pain were significantly lower in the LTEA group than in the LA group (P < 0.0001). The anesthesia satisfaction rate was 90.0% in the LTEA group and 72.5% in the LA group (P < 0.005). MAP and HR values in the LTEA group were significantly lower than those in the LA group (P < 0.05). The total dose of fentanyl in the LTEA group was significantly lower than that in the LA group (P < 0.05). As for ODI values, the average operation time, X-ray exposure time, and incidence of complications were not significantly different between the two groups (P > 0.05). Conclusions LTEA simplifies the process of EA and can achieve a good analgesic effect intraoperatively without increasing the preoperative preparation time; thus, it may be adopted as an alternative mode of anesthesia during PTED surgery.

Comparative Pain Satisfaction With Transforaminal Epidural Steroid Injection Plus Caudal Epidural Steroid Injection With Catheter Versus Tranforaminal Epidural Steroid Injection Plus Lumbar Interlaminar Epidural Steroid Injection in Patients Having Low Backache With Radiculopathy or Radicular Pain

“…In a study, females comprised the majority of the sample. (9). Exploring the epidural space of the TFESI is somewhat challenging in a significantly deteriorated and constricted foramen.…”

S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study

“…In 2022, Zhang et al included 160 PTED candidates and divided them into two groups, one receiving transforaminal EA and the other LA (28). They showed that the satisfaction rate and lumbar and leg VAS scores were significantly lower in the transforaminal EA group (28).…”

“…In 2022, Zhang et al included 160 PTED candidates and divided them into two groups, one receiving transforaminal EA and the other LA (28). They showed that the satisfaction rate and lumbar and leg VAS scores were significantly lower in the transforaminal EA group (28). A systematic review conducted by Zhen et al also confirmed that the satisfaction rate is statistically higher among patients who received EA (26).…”

Perioperative pain management for spine surgeries

“…No additional benefits were seen when preinduction administration of ITM by an anesthesiologist was compared with intraoperative administration by surgeons 66 . Epidural single-injection analgesia has been reported for percutaneous transforaminal endoscopic discectomy, where the surgeon injects the drug through a transforaminal approach under fluoroscopic guidance 67 . Single-injection epidural injections, whether performed by an anesthesiologist preinduction 68 or a surgeon intraoperatively, 69 have shown decreased LOS in addition to pain relief and patient satisfaction.…”

“…Erector spinae plane block [47][48][49][50][51][52][53] Most studied block in adult spine surgeries Associated with reduced opioid consumption intraoperatively and postoperatively, lower pain scores, less NV and better patient satisfaction More comparative effectiveness studies are required Most studied block in pediatric spine surgeries Associated with reduced opioid consumption intraoperatively and postoperatively, lower pain scores, less NV and better patient satisfaction More comparative effectiveness studies are required Thoracolumbar interfascial plane block [56][57][58][59] Limited studies with mixed results Not studied Midpoint transverse process to pleura block 45,46 Inadequate data Not studied Quadratus lumborum block 60 Single retrospective study Can be used for anterior and posterior approach lumbar spine surgeries Not studied Surgical infiltration [67][68][69][70][71][72][73][74]…”