Fang Guofang, Ding Zihai, Song Zhihui
Anatomical Institute of Minimally Invasive surgery, Southern Medical University, Guangzhou 510515, China; Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, NO.1333, Xinhu Road, Shenzhen, 518100, China.
Anatomical Institute of Minimally Invasive surgery, Southern Medical University, Guangzhou 510515, China.
Pain Physician. 2016 Sep-Oct;19(7):E1001-4.
Percutaneous endoscopic lumbar discectomy (PELD) is a standard technique for the treatment of lumbar disc hernia. Thus far, most surgeons have recommended local anesthesia. However, in clinical practice, some patients experience pain and are unable to cooperate with the surgery during intervertebral foramen hemp expansion. The use of general anesthesia may create a greater risk of complications because of nerve root anomalies; thus, intraoperative neurophysiological monitoring should be utilized. Reports regarding the use of epidural anesthesia are few in comparison.
To investigate the risks and contingency plans of epidural anesthesia in lumbar transforaminal endoscopic surgery.
A retrospective analysis of all lumbar transforaminal endoscopic surgeries performed from 2010 to 2014.
Kanghua hospital.
Patients treated with local and epidural anesthesia were divided into 2 groups. In local anesthesia group (A) and local anesthesia group (B), 0.5% lidocaine and 0.25% ropivacaine was administered, respectively. The incidences of complications, including urological complications, in each surgical group as well as Oswestry disability idex (ODI) improvement rates, postoperative patient satisfaction rates, and x-ray exposure times were assessed.
From 2010 to 2014, there were 286 cases of lumbar transforaminal endoscopic surgeries, 121 cases utilizing local anesthesia and 165 cases utilizing epidural anesthesia. In cases in which neurological complications occurred after surgery, 15 cases involved nerve root numbness, including one case of foot drop and 2 cases of cerebrospinal leakage in the local anesthesia group, which accounted for 12.4% of group A. However, in the epidural anesthesia group, which accounted for 9.70% of group B, there were 16 cases of nerve root numbness, including 2 cases of foot drop and 2 cases of cerebrospinal leakage. No significant difference was detected in the incidence of neurological complications between the 2 groups (P > 0.05). The ODI improvement rates were 86.0% in the local anesthesia group and 85.4% in the epidural anesthesia group (P > 0.05). The average x-ray exposure times were 14.7 seconds and 16 seconds in the local anesthesia group and epidural anesthesia group, respectively (P > 0.05). The postoperative patient satisfaction rates were 73.6% and 91% in the local anesthesia group and epidural anesthesia group, respectively (P < 0.001).
This was a single-blind study, and the complications observed were related to the learning curve; all these factors may lead to biases.
Epidural anesthesia in transforaminal lumbar surgery is feasible and safe, and no significant difference in neurological complications was observed between the epidural anesthesia and the local anesthesia groups. However, for the patients concerned, the postoperative patient satisfaction rate was significantly greater in the epidural anesthesia group. It is noteworthy that the x-ray exposure times of the groups were not significantly different.
Epidural anesthesia, transforaminal lumbar surgery, neurological complications, cerebrospinal leak.
经皮内镜下腰椎间盘切除术（PELD）是治疗腰椎间盘突出症的标准技术。到目前为止，大多数外科医生推荐局部麻醉。然而，在临床实践中，一些患者会感到疼痛，并且在椎间孔麻醉扩展过程中无法配合手术。由于神经根异常，全身麻醉可能会带来更大的并发症风险；因此，应采用术中神经生理监测。相比之下，关于硬膜外麻醉使用的报道较少。
探讨硬膜外麻醉在腰椎椎间孔镜手术中的风险及应对措施。
对2010年至2014年期间所有的腰椎椎间孔镜手术进行回顾性分析。
康华医院。
接受局部麻醉和硬膜外麻醉的患者分为两组。局部麻醉组（A）和局部麻醉组（B）分别给予0.5%利多卡因和0.25%罗哌卡因。评估每个手术组的并发症发生率，包括泌尿系统并发症，以及Oswestry功能障碍指数（ODI）改善率、术后患者满意度和X线照射时间。
2010年至2014年，共有286例腰椎椎间孔镜手术，其中12l例采用局部麻醉，165例采用硬膜外麻醉。术后发生神经并发症的病例中，局部麻醉组有15例出现神经根麻木，其中1例足下垂，2例脑脊液漏，占A组的12.4%。而硬膜外麻醉组占B组的9.70%，有16例神经根麻木，其中2例足下垂，2例脑脊液漏。两组神经并发症发生率差异无统计学意义（P>0.05）。局部麻醉组的ODI改善率为86.0%，硬膜外麻醉组为85.4%（P>0.05）。局部麻醉组和硬膜外麻醉组的平均X线照射时间分别为14.7秒和16秒（P>0.05）。局部麻醉组和硬膜外麻醉组的术后患者满意度分别为73.6%和91%（P<0.001）。
这是一项单盲研究，观察到的并发症与学习曲线有关；所有这些因素可能导致偏差。
腰椎椎间孔镜手术中硬膜外麻醉是可行且安全的，硬膜外麻醉组和局部麻醉组在神经并发症方面无显著差异。然而，对于相关患者，硬膜外麻醉组的术后患者满意度明显更高。值得注意的是，两组的X线照射时间无显著差异。
硬膜外麻醉；腰椎椎间孔镜手术；神经并发症；脑脊液漏
