Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China.
Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
Sci Rep. 2022 May 6;12(1):7427. doi: 10.1038/s41598-022-11393-4.
It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.
在局部麻醉下进行经皮内窥镜腰椎间盘切除术治疗腰椎间盘突出症（LDH）患者时，如何实现即时术中反馈和满意的手术体验仍然是一个未解决的问题。在此，我们比较了局部麻醉与局部麻醉联合清醒镇静在经皮内窥镜腰椎间盘切除术中对 LDH 患者的镇痛和镇静效果。共纳入 92 例 LDH 患者，分为以下几组：对照组（Con 组）、右美托咪定组（Dex 组）、羟考酮组（Oxy 组）和右美托咪定+羟考酮组（Dex+Oxy 组）。比较了各组患者麻醉前（T1）、工作套管建立时（T2）、髓核切除时（T3）和术后即刻（T4）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和 Ramsay 评分等各项指标。还评估了临床结果，包括视觉模拟评分（VAS）、手术时间、住院时间、Macnab 标准和 SF-36 评分。在所有组中，Dex+Oxy 组在 T2 和 T3 时 MAP 和 HR 最稳定。各组的 VAS、住院时间、Macnab 标准和 SF-36 评分等临床结果无显著差异（p＞0.05）。局部麻醉联合清醒镇静是一种安全有效的方法，可改善手术体验，为 LDH 患者在经皮内窥镜腰椎间盘切除术中获得满意的临床结果。
