Comparison of the Safety and Effectiveness of Percutaneous Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation Under Epidural Anesthesia and General Anesthesia

Abstract

Objective: To assess the safety and effectiveness of percutaneous endoscopic lumbar discectomy (PELD) under epidural anesthesia (EA) and general anesthesia (GA) for treating lumbar disc herniation (LDH). Methods: A retrospective study involving 86 patients with LDH managed by PELD under EA and GA was conducted from July 2018 to March 2019. These patients were divided into 2 groups according to the type of anesthesia. Patient's demographics data as well as the operation time, complications, fluoroscopy shots, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and MacNab scores of the 2 groups were recorded. All of the patients were followed-up at 6 months after operation. Results: There were no significant differences were detected in the preoperative demographics between the groups (p > 0.05). Two cases (4.8%) under GA developed transient motor weakness, 3 cases (7.4%) presented numbness of lower limb, and 1 case (2.4%) had cauda equina syndrome after operation. In EA group, 1 case (2.2%) had motor weakness and 3 cases (6.7%) had lower limb numbness, which resolved completely at the last follow-up. There was significant difference between preoperative VAS, JOA, and ODI scores and postoperative scores (p < 0.01). Moreover, there were no differences in the operation time, fluoroscopy shots, and MacNab scores between the 2 groups (p > 0.05). Conclusion: EA and GA in PELD are effective and safe, and no significant difference in complications was observed. Based on our experience, we recommended junior surgeons to perform PELD under EA for getting feedback from the patient to avoid nerve injury and reduce the radiation dose. The concentration of ropivacaine in EA should be considered carefully.

Effect Analysis of Epidural Anesthesia with 0.4% Ropivacaine in Transforaminal Endoscopic Surgery

“…It not only has good analgesic effect but also can preserve the motor function of patients' lower limbs. The operator can detect the nerve injury by observing the movement of patients' toes during the operation [ 5 , 11 ]. But this method has a lag, and once the motor function is damaged, nerve damage occurs.…”

“…e operator can detect the nerve injury by observing the movement of patients' toes during the operation [5,11]. But this method has a lag, and once the motor function is damaged, nerve damage occurs.…”

“…The other advantage is that the motor function of the lower limbs of the patients remains when the concentration of local anesthetics is low. The surgeon can detect the nerve injury by observing the movement of the toes of the patients [ 5 , 11 ]. However, this is not the indicator that the surgeon really wants.…”

“…Routine epidural anesthesia often uses 0.5% ropivacaine; although the analgesia is perfect, the nerve root tactile and lower limb motor function of patients are completely lost. Ren et al [ 11 ] found that the analgesic effect of epidural anesthesia was satisfactory even when the concentration of ropivacaine was reduced to 0.375%. Therefore, when the concentration of ropivacaine is between 0.375% and 0.5%, there is an appropriate concentration, which can not only provide enough analgesia for patients but also retain nerve root tactile sensation.…”

Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation

“…One study reported that the procedure may have to be stopped because of severe pain. 12 Since epidural anesthesia (EA, referred to here as MA, modified anesthesia) with ropivacaine can preserve motor function of the lower limbs and selectively block sensation during surgery, 13 in the present study, we introduced a modified anesthesia technique based on the sensation-motion separation effect of ropivacaine and the synergistic effect of sufentanil 14 as a compromise method in an attempt to create a situation in which both patients and surgeons could achieve favorable intraoperative experiences.…”