Wang Xin, Shen Junjie, Chen Zhiheng, Cai Bin, Chen Yuanyuan, Zhang Guowang, Xu Jianguang, Lian Xiaofeng
Department of Orthopedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clin Spine Surg. 2025 Aug 1;38(7):E364-E370. doi: 10.1097/BSD.0000000000001743. Epub 2024 Dec 9.
A prospective randomized clinical trial.
In this study, we compared local anesthesia with 1% lidocaine (LA) and general anesthesia (GA) utilized in PEID at L5/S1 disc herniation.
Given the anatomic characteristics of L5/S1 segment, interlaminar approach was preferred to perform endoscopic discectomy for L5/S1 disc herniation. Typically, general anesthesia was used for interlaminar approach. However, with general anesthesia, nerve damage during surgery due to being unable to monitor patient status is a main concerned for surgeons. As an alternative option, local anesthesia has been developed recently. But, the optimal type of anesthesia for PEID remains controversial.
From March 2021 to March 2023, 103 consecutive patients with L5/S1 disc herniation who planned to undergo PEID in our unit were randomized to the LA group (n=53) or GA group (n=50). Both groups were followed up for at least 24 months. Surgical-related parameters, clinical outcomes, and complications were compared between the 2 groups.
The mean operative time and bed rest time were shorter in the LA group than in the GA group (both P <0.001). The estimated blood loss in the LA group was greater than that in the GA group ( P <0.001). The cost of hospitalization in the LA group was significantly lower than that in the GA group ( P <0.001). At every time point of follow-up, there was no significant difference between the 2 groups in terms of VAS, ODI, and modified MacNab criteria. The satisfaction surveys showed that more patients in the LA group would choose contrary anesthesia, including 6 patients who were administered extravenously injected sufentanil intraoperatively due to intensive pain. Postoperative neuropathic abnormalities were rarer in the LA group.
Both local anesthesia using 1% lidocaine and general anesthesia are effective and safe for PEID at the L5/S1 segment. The use of local anesthesia is preferable due to its associated reductions in operative time, bed rest duration, and economic costs.
一项前瞻性随机临床试验。
在本研究中，我们比较了1%利多卡因局部麻醉（LA）和全身麻醉（GA）在L5/S1椎间盘突出症经皮内镜下椎间盘切除术（PEID）中的应用。
鉴于L5/S1节段的解剖特点，椎板间入路是L5/S1椎间盘突出症行内镜下椎间盘切除术的首选方法。通常，椎板间入路采用全身麻醉。然而，采用全身麻醉时，由于无法监测患者状态，手术过程中的神经损伤是外科医生主要关注的问题。作为一种替代选择，局部麻醉最近得到了发展。但是，PEID的最佳麻醉方式仍存在争议。
2021年3月至2023年3月，在我院计划行PEID的103例连续L5/S1椎间盘突出症患者被随机分为LA组（n=53）或GA组（n=50）。两组均随访至少24个月。比较两组的手术相关参数、临床结局和并发症。
LA组的平均手术时间和卧床休息时间均短于GA组（均P<0.001）。LA组的估计失血量大于GA组（P<0.001）。LA组的住院费用显著低于GA组（P<0.001）。在随访的每个时间点，两组在视觉模拟评分（VAS）、腰椎功能障碍指数（ODI）和改良MacNab标准方面均无显著差异。满意度调查显示，LA组更多患者会选择相反的麻醉方式，其中6例患者因术中疼痛剧烈而静脉注射舒芬太尼。LA组术后神经病变异常较少见。
1%利多卡因局部麻醉和全身麻醉在L5/S1节段的PEID中均有效且安全。由于局部麻醉可缩短手术时间、卧床休息时间并降低经济成本，因此更可取。
