Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, 315040, Zhejiang, China.
Ningbo University School of Medicine, Ningbo, 315211, Zhejiang, China.
BMC Musculoskelet Disord. 2024 Oct 2;25(1):774. doi: 10.1186/s12891-024-07898-w.
Interlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited.
The propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively.
Fifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05).
SA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia.
经皮内窥镜下腰椎间盘切除术（IEDL）是治疗腰椎间盘突出症的一种常用方法。在 IEDL 过程中常采用局部麻醉（LA），但其具有优点和缺点。椎管内麻醉（SA）是 IEDL 的一种可行的麻醉策略；然而，目前临床研究数据的可用性有限。
采用倾向评分匹配法确保 SA 组和 LA 组的可比性。观察指标为手术时间、术中视觉模拟评分（VAS）、辅助镇痛需求、术中生命体征、出血量、不良手术事件、麻醉相关并发症、术后卧床时间、术后 2 小时 VAS 疼痛评分、Oswestry 功能障碍指数（ODI）评分、对手术疗效的满意度以及术后 6 个月再次手术的意愿。
每组 56 例患者。两组间术中 VAS 疼痛评分、辅助镇痛药物使用、再次手术意愿、最大术中收缩压和变异度存在显著差异（P<0.05）。与 LA 组相比，SA 组术后 2 小时 VAS 疼痛评分较低，手术时间较长，术后卧床时间较长，麻醉相关并发症较多（P<0.05）。两组间术中心率变异性、出血量、ODI、对手术疗效的满意度和手术相关并发症无显著差异（P>0.05）。
SA 作为 IEDL 手术的替代麻醉方法具有很大的优势，与 LA 相比具有更好的疗效。然而，由于这种麻醉方式存在潜在风险，因此仔细评估适应证至关重要。
