Comparison of the effects of general and local anesthesia in lumbar interlaminar endoscopic surgery

Abstract

Background: Percutaneous endoscopic lumbar discectomy (PELD) with an interlaminar approach is a technique used to treat lumbar disc hernia. It has not yet been established whether general or local anesthesia (LA) is preferable for lumbar interlaminar endoscopic surgery. Methods: Between October, 2012 and June, 2016, 60 patients were recruited and randomly divided into 2 groups: the general anesthesia (GA) group and the LA group. The patients' basic clinical data, intraoperative patient experience, Oswestry disability index (ODI), visual analog scale (VAS) score, and the postoperative patient satisfaction rate were assessed.Results: Statistically significant differences were found between the two groups in operative time and length of hospital stay. There were no significant differences in postoperative ODI or VAS scores between the two groups during follow-up at 3, 6, and 12 months. One patient in the GA group sustained a nerve root injury intraoperatively. Two patients in the LA group suffered adverse reactions, as did six patients in the GA group. However, 50% of the patients expressed fear about undergoing the surgery with LA, while all patients felt they could undergo the same surgery with GA.Conclusions: General and LA are both suitable for use in lumbar interlaminar endoscopic surgery.However, GA makes a positive intraoperative surgical experience more likely for the patient.

Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study

“…Several authors have compared the effect of GA and LA on the clinical outcome of PELD via the interlaminar approach. Ye et al included 60 patients with lumbar disc hernia who were treated with PELD with an interlaminar approach [ 11 ]. At each follow-up of 3, 6, and 12 months after surgery, there was no significant difference in ODI and VAS scores between GA and LA.…”

“…Except for Chen et al [ 12 ], who did not elaborate on specific anesthetic drugs, the other three studies reported the specific composition of the LA anesthetic drug [ 11 , 13 , 14 ]. The duration of anesthesia with a single dose of lidocaine may not be long enough for PELD.…”

“…The duration of anesthesia with a single dose of lidocaine may not be long enough for PELD. Instead of using lidocaine alone [ 13 ], a mixture of ropivacaine and lidocaine was applied in the Ye et al and Wu et al studies [ 11 , 14 ]. We also added ropivacaine with a longer half-life to enhance the anesthetic efficacy and extend the duration of anesthesia.…”

“…However, several researchers have confirmed the feasibility of conducting percutaneous endoscopy interlaminar lumbar discectomy with local anesthesia (LA), citing the advantages of a faster recovery, shorter hospital stay, lower hospital cost, and fewer complications, such as postoperative cognitive dysfunction and iatrogenic nerve root injury. However, anesthesia-related complications, including nausea and vomiting, as well as a poor anesthetic effect, are noted in these studies [ 11 – 14 ].…”

Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study

“…However, anesthesia-related complications, including nausea and vomiting, as well as a poor anesthetic effect, are noted in these studies. [11][12][13][14] In the present study, we evaluated modifying the proportion and administration of local anesthetics and rst propose the technique of gradient LA. The aim of our study was to explore the e cacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient LA in patients with L5/S1 disc herniation.…”