Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan.
Department of Orthopaedic Surgery, Sendai Nishitaga National Hospital, Sendai, Miyagi, Japan.
Neurol Med Chir (Tokyo). 2021 Mar 15;61(3):236-242. doi: 10.2176/nmc.oa.2020-0275. Epub 2021 Jan 28.
Transforaminal full-endoscopic lumbar discectomy (TELD) can be performed under local anesthesia. However, there have been no reports on risk factors for a change in vital signs or the need for additional medications to maintain adequate analgesia during this procedure. The purpose of this study was to identify risk factors for additional intravenous medication during TELD under local anesthesia. The following factors were retrospectively evaluated in 113 consecutive patients who underwent TELD under local anesthesia at our institution: demographic characteristics, radiological features at the intervertebral disc level, distance between the superior articular process and the exiting nerve root, height of the intervertebral disc, height of the bulging disc, height of the intervertebral foramen, and distance from the insertion site to the spinous process on magnetic resonance imaging (MRI) and computed tomography (CT) scans of the lumbar spine. Logistic regression analysis was performed to determine factors associated with the need for additional drugs. In all, 23 cases (20.4%) required additional intraoperative medications because of hypertension, hypotension, bradycardia, or pain. Logistic regression analysis revealed that age (partial regression coefficient 0.05, p = 0.02) and bulging disc height (partial regression coefficient -0.7, p = 0.003) influenced the need for additional drugs. There were significant associations of need for additional intravenous medication with older age (>62 years) and a smaller bulging disc height (<8.2 mm). Patients with these factors require close monitoring for changes in vital signs or increasing pain when performing TELD under local anesthesia and may need additional intravenous medication.
经皮椎间孔内窥镜下腰椎间盘切除术（TELD）可在局部麻醉下进行。然而，目前尚无关于该手术过程中生命体征变化或需要额外药物以维持充分镇痛的危险因素的报告。本研究旨在确定在局部麻醉下行 TELD 时需要额外静脉药物的危险因素。我们回顾性评估了在我院接受局部麻醉下 TELD 的 113 例连续患者的以下因素：人口统计学特征、椎间盘水平的影像学特征、上关节突与神经根出口之间的距离、椎间盘高度、椎间盘膨出高度、椎间孔高度和磁共振成像（MRI）和腰椎 CT 扫描上从插入部位到棘突的距离。采用逻辑回归分析确定与需要额外药物相关的因素。共有 23 例（20.4%）因高血压、低血压、心动过缓或疼痛需要额外的术中药物。逻辑回归分析显示年龄（偏回归系数 0.05，p = 0.02）和椎间盘膨出高度（偏回归系数-0.7，p = 0.003）影响了对额外药物的需求。需要额外静脉药物与年龄较大（>62 岁）和椎间盘膨出高度较小（<8.2mm）有显著关联。在局部麻醉下进行 TELD 时，具有这些因素的患者需要密切监测生命体征变化或疼痛加剧，并可能需要额外的静脉药物。
