Kang Seung Youn, Cho Hae Sun, Yi Jihwan, Kim Hyeun Sung, Jang Il Tae, Kim Do-Hyeong
Department of Anesthesiology and Pain Medicine, Nanoori Hospital Gangnam, Seoul, South Korea.
Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, South Korea.
World Neurosurg. 2022 Mar;159:e103-e112. doi: 10.1016/j.wneu.2021.12.019. Epub 2021 Dec 8.
With advances and refinements in endoscopic lumbar spine surgery showing effective and satisfactory results, the need for simple yet effective anesthetic techniques for minimally invasive endoscopic spine surgery has increased. The aim of this study was to compare feasibility and postoperative outcomes of fluoroscopy-guided epidural anesthesia with general anesthesia in patients undergoing endoscopic lumbar decompression surgery (≤3 levels).
Patients who underwent 1-3 levels of endoscopic lumbar decompression surgery under either fluoroscopy-guided epidural or general anesthesia between January 2019 and October 2020 were retrospectively reviewed. Postoperative pain intensity and use of rescue analgesics for up to 48 hours were compared between the epidural and general anesthesia groups. Intraoperative anesthetic data and postoperative recovery profiles were also analyzed.
Postoperative pain scores were significantly lower in the epidural anesthesia group compared with the general anesthesia group at 10 minutes after recovery room admission (2.1 ± 1.8 vs. 5.7 ± 1.9, P < 0.001), 24 hours postoperatively (3.3 ± 1.0 vs. 5.4 ± 1.8, P < 0.001), and 48 hours postoperatively (3.2 ± 0.6 vs. 4.4 ± 1.4, P < 0.001). The proportion of patients requiring rescue analgesics in the recovery room was significantly lower in the epidural anesthesia group (1.9% vs. 20.5%, P = 0.027). The median 15-item Quality of Recovery score on postoperative day 1 was significantly higher in the epidural anesthesia group (118.0 [113.5-123.0] vs. 82.0 [73.5-111.5], P < 0.001). Occurrence of nausea, vomiting, and voiding difficulty up to 48 hours postoperatively did not differ between groups.
Compared with general anesthesia, epidural anesthesia provided better analgesia and recovery characteristics during the early postoperative period in endoscopic lumbar decompression surgery.
随着内镜腰椎手术的进展与完善，其显示出有效且令人满意的结果，对于微创内镜脊柱手术而言，对简单而有效的麻醉技术的需求增加。本研究的目的是比较荧光镜引导下硬膜外麻醉与全身麻醉在接受内镜下腰椎减压手术（≤3个节段）患者中的可行性及术后结果。
回顾性分析2019年1月至2020年10月期间在荧光镜引导下硬膜外麻醉或全身麻醉下行1 - 3个节段内镜下腰椎减压手术的患者。比较硬膜外麻醉组和全身麻醉组术后48小时内的疼痛强度及补救性镇痛药的使用情况。同时分析术中麻醉数据及术后恢复情况。
术后恢复室入室10分钟时，硬膜外麻醉组的术后疼痛评分显著低于全身麻醉组（2.1±1.8 vs. 5.7±1.9，P<0.001）；术后24小时（3.3±1.0 vs. 5.4±1.8，P<0.001）；术后48小时（3.2±0.6 vs. 4.4±1.4，P<0.001）。硬膜外麻醉组在恢复室需要补救性镇痛药的患者比例显著更低（1.9% vs. 20.5%，P = 0.027）。术后第1天硬膜外麻醉组15项恢复质量评分中位数显著更高（118.0[113.5 - 123.0] vs. 82.0[73.5 - 111.5]，P<0.001）。术后48小时内两组恶心、呕吐及排尿困难的发生率无差异。
与全身麻醉相比，硬膜外麻醉在内镜下腰椎减压手术术后早期提供了更好的镇痛效果及恢复特征。
