Sedation for Percutaneous Endoscopic Lumbar Discectomy

Oksar, Menekse

doi:10.1155/2016/8767410

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Most articles mention the use of local anaesthesia for spine surgeries in high risk subjects (ASA class iii and iv) 10) . In the modern era, local anaesthesia in spine surgeries is generally used for Trans-foraminal endoscopic discectomies 5,11,14) . According to our knowledge, there are only few reports of the use of local epidural anaesthesia in MED.…”

Section: Discussionmentioning

confidence: 99%

Tubular Micro-Discectomy Under Local Epidural Anaesthesia: A Technical Note

Kulkarni

Sharma

Kunder

2019

J Minim Invasive Spine Surg Tech

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Objective: Day-care surgery maximizes utilization of healthcare and aids in early return to work. Minimally invasive spine surgery (MISS) under local epidural anesthesia is a step in this direction. The combination of minimal surgical trauma and nominal sedation results in quick recovery and early discharge. To present our experience of performing lumbar tubular micro-discectomy under local epidural anaesthesia. Methods: A case report of 10patients operated for lumbar herniated discs under local epidural anaesthesia. The patients had radicular pain since a few months with MRI evidence of herniated nucleus pulposus and failure of 6 weeks of conservative trial before surgery. The outcomes were assessed with ODI, VAS and Mac-Nab criteria. Premedication with Dexmedetomidine, local infiltration of lignocaine and bupivacaine with bolus dose of fentanyl during root manipulation facilitated the execution of the procedure. Results: All patients obtained dramatic pain relief postoperatively. The procedure was well tolerated except for the slight discomfort during varying degrees of nerve-root retraction. Patients were made to walk and oral diet allowed after an hour and discharge was within 24 hours of the procedure. The VAS improved from 8.4 to 2.3 and ODI from 58.2 to 22.8. Follow-up was at 1, 6, 12 and 24 weeks. No complications such as dural tear, nerve root injury etc. were seen. Conclusion: Microtubular discectomy under local epidural anaesthesia is a feasible option in experienced hands. Apart from reducing the effects of general anaesthesia, it reduces the hospital stay and cost. It is an evolution of microtubular discectomy towards day care surgery.

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Section: Discussionmentioning

confidence: 99%

Tubular Micro-Discectomy Under Local Epidural Anaesthesia: A Technical Note

Kulkarni

Sharma

Kunder

2019

J Minim Invasive Spine Surg Tech

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“…The Newcastle-Ottowa Scale 6 was used to assess the quality of the included studies. Several reviewers reviewed each study working independently and discrepancies were adjudicated by a third author.…”

Section: Methodsmentioning

confidence: 99%

“…[3][4][5] Percutaneous endoscopic lumbar discectomy can be performed under both general anesthesia (GA) or local ± epidural anesthesia (LA). 6 Local ± epidural anesthesia is now being recommended by some spine surgeons due to its rapid analgesic onset, shorter operative times, decreased systemic complications, and adequate intraoperative and postoperative pain control. 7,8 Downsides to LA include patient discomfort potentially necessitating shorter operative times, in addition to a diminished ability to maintain strict hemodynamic and anesthetic parameters and risk of insufficient discectomy.…”

Section: Introductionmentioning

confidence: 99%

General vs Local Anesthesia for Percutaneous Endoscopic Lumbar Discectomy (PELD): A Systematic Review and Meta-Analysis

Mooney

Laskay

Erickson

et al. 2022

Global Spine Journal

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Study Design Systematic review Objectives It remains unknown whether general anesthesia (GA) or local ± epidural anesthesia (LA) results in superior outcomes with percutaneous endoscopic lumbar discectomy (PELD). The present study sought to examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications with PELD. Methods Systematic review and meta-analysis examining PELD performed under GA or LA was conducted. Patient-reported outcomes including Visual Analog Scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complication, recurrent disc herniation, durotomy, and reoperation rates as well as surgical data were recorded. All outcomes were compared between pooled studies examining GA or LA. Results Sixty-eight studies consisting of 5269 patients (724 GA, 4465 LA) were included in the meta-analysis. Overall complication rate was significantly higher in the GA group (9% vs 4%, P = .003). Durotomy rates, length of stay, recurrent disc herniation and reoperation rates were similar between groups. At the first follow-up timepoint, the LA group demonstrated significant improvements in VAS back and ODI scores ( P < .05) while the GA group did not ( P > .05). At the final follow-up (> 6 months), the percent of patients achieving an excellent McNab score was significantly higher in the GA vs LA group ( P < .001). Conclusions Percutaneous endoscopic lumbar discectomy with LA may be associated with greater short-term improvement in VAS back pain and ODI scores. General anesthesia may be associated with more durable pain relief but a higher complication rate. Further systematic investigation is necessary to determine what short and long term benefits are associated with PELD performed under LA and GA.

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“…However, these complications can be potentially avoided with various endoscopic spinal procedures that can be done under local anaesthesia and epidural anaesthesia, which allow for early postoperative recovery and mobility without a significant effect on the central nervous system. [32][33][34][35][36]…”

Section: In Sickness: the Role Of Endoscopic Spine Surgery In Patientmentioning

confidence: 99%