A Prospective Randomized Study Comparing Perioperative Outcome Variables After Epidural or General Anesthesia for Lumbar Disc Surgery

Demirel, Cengiz Bekir; Kalayci, Murat; Özkoçak, Işıl; Altunkaya, Hanife; Özer, Yetkin; Açıkgöz, Bektaş

doi:10.1097/00008506-200307000-00005

Cited by 72 publications

(79 citation statements)

References 24 publications

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“…The needle was placed parallel to the disc space, midway between the endplates, proximal to the annulus, with the tip lateral to the medial border of the pedicles. Prior to the procedure, using indigocarmine dye, evocative chromodiscography was performed 5,7) . A guide wire was inserted through the needle channel into the annulus, and then a skin incision, about 1 cm in length, was made at the entry needle site.…”

Section: Case Reportmentioning

confidence: 99%

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy

Kim¹,

Kim

et al. 2009

J Korean Neurosurg Soc

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We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with packed red blood cells and placed at absolute bed rest. After observing the patient in intensive care, the severe flank and leg pain subsided, but the mild back pain persisted. Although percutaneous endoscopic lumbar discectomy is an effective minimally invasive surgical technique for the treatment of lumbar disc herniation, this case highlights the inherent risks of acute lumbar segmental vessel injury.

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Section: Case Reportmentioning

confidence: 99%

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy

Kim¹,

Kim

et al. 2009

J Korean Neurosurg Soc

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“…This has been described in studies comparing either spinal or epidural anesthesia with general intubation narcosis [3][4][5][6][7][8][9][10][11] but this will not be further highlighted below. As it is difficult to make a distinction among studies that have described the combination of general anesthesia or propofol sedation combined with either epidural 'anesthesia' or 'analgesia', these studies will be discussed under the same denominator as all studies that have combined general anesthesia with a neuraxial technique intended for postoperative analgesia purposes.…”

Section: Experience With Local and Regional Analgesia Techniquesmentioning

confidence: 99%

“…Other advantages were less side-effects such as nausea/vomiting [9,34,41,53,55], faster return of bowel function and oral intake [23, 48,54], faster ambulation [52], enhanced patient satisfaction and in a few studies faster hospital discharge [21].…”

Section: Epidural Analgesiamentioning

confidence: 99%

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

N-M¹,

Mb²,

Sermeus³

et al. 2015

J Spine

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The use of regional analgesia techniques for postoperative analgesia in spine surgery is less frequently used in comparison with conventional oral and parenteral treatment. This may be explained by the fact that surgery is mostly performed under general anesthesia. Although objections of the surgeon are comprehensible, there is a growing number of studies using regional techniques for the treatment of pain after this surgery.When postoperative analgesia is the focus then regional techniques can be initiated at any time-point of the procedure while all ages and types of surgery, even extensive scoliosis fusion may benefit from it. The present overview will focus on the feasibility of (loco)regional techniques to be used for postoperative analgesia, medications used alone or in combination, as a single bolus or through persistent catheters and with special attention to pain relief following scoliosis repair.In general neuraxial techniques offer lower pain scores and/or less need for opioid rescue in comparison with systemic conventional analgesia although much less benefit may be noticed in patients operated for spinal fusion than for disc surgery, laminectomy and adolescent scoliosis correction. The actual literature provides little evidence with respect to the best timing of initiation, the best route nor the best dose in relationship to the type of surgery. Besides neuraxial techniques several alternatives have found their way in this type of intervention. As all techniques described offered variable success rates, future research is mandatory to determine their superiority over general anesthesia and conventional pain therapy modalities.

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“…However, more interest has recently been given to regional anesthetic techniques for lumbar Akakın A. et al: Epidural Anesthesia in Lumbar Microdiscectomy Surgery discectomy surgery performed under operative microscope (1). Regional anesthesia can be used for lower thoracic or lumbar spinal procedures (5).…”

Section: Introductionmentioning

confidence: 99%

“…However, epidural anesthesia is safer than spinal anesthesia in cardiac and neurological aspects (11). A good anesthetic should have some properties: rapid onset, rapid arousal after cessation, stable hemodynamic profile, reduced blood transfusion need, decreased postoperative side effects (nausea, vomiting), reduced pain in the post-operative period with lesser additional narcotics (1,5). Epidural anesthesia has some advantages over general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Epidural anesthesia in elective lumbar microdiscectomy surgery: is it safe and effective?

Akakın

Yılmaz²,

Akay³

et al. 2014

Turkish Neurosurgery

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AIm:The aim of this study was to evaluate effectiveness and safety of epidural anesthesia in elective lumbar microdiscectomy surgery. mATErIAl and mEThOds: Twenty-seven patients (78%, female), who were admitted for single level simple microdiscectomy surgery between May 2012 and December 2013 in single spine center of a university hospital, were enrolled into the study. Clinical evaluations with demographical and per-operative data were collected prospectively. rEsulTs: Mean age was 60.04 years. Mean weight, height, and BMI of the study population were 77.7 kg, 160.22 cm, 30.26; respectively. Mean operation duration was 45.56 minutes. Mean VAS score for pain was 0.78 at immediate post-op, 0.52 at 4th hour, and 0.35 at post-operative 24 th hour. Ramsay sedation scale (RSS) scores steadily decreased from 2.07 in the immediate post-operative time to 1.93 at 4 th hour and 1.88 at 24 th hour. The only correlation seen between patient demographics and RSS was body weight seen in immediate post-operative period. Improvements for VAS scores for pain at 4 th and 24 th hours were 28% and 31%; respectively. Three patients had nausea, one of them vomited after the surgery. All patients were satisfied and would consider epidural anesthesia in future similar surgeries. CONClusION:Epidural anesthesia provides a safe and effective method for elective lumbar microdiscectomy surgery. KEywOrds:Regional anesthesia, Epidural anesthesia, Lumbar microdiscectomy, Neurosurgery ÖZ AmAÇ: Çalışmada, elektif lomber mikrodiskektomi cerrahisinde epidural anestezinin güvenirliğini ve etkinliğini değerlendirmeyi amaçladık. yÖNTEm ve GErEÇlEr: Tek seviye lomber disk hernisi tanısı ile opere edilmek üzere bir üniversite hastanesinin omurga cerrahisi merkezine Mayıs 2012 ile Aralık 2013 tarihleri arasında başvuran ve çalışmaya katılmayı kabul eden 27 hasta (%78'I kadın) çalışmaya dahil edildi. Hastaların klinik, demografik ve per-operatif verileri prospektif olarak toplandı.BulGulAr: Ortalama yaş 60,04 yıldı. Hastaların ortalama kilo, boy ve vücut kitle indeksleri sırasıyla 77,7 kg, 160,22 cm, 30,26'ydı. Ameliyat ortalama süresi 45,56 dakikaydı. Ağrı için VAS skoru erken post-operatif dönemde 0,78'di, post-operatif 4. saatte 0,52'ye ve 24. saatte 0,35'e düştü. Ramsay sedasyon skalası (RSS) skoru post-operatif erken dönemde 2,07'ydi, 4. saatte 1,93'e, 24. saatte 1,88'e geriledi. Hastaların demografik verileri ile RSS skorunun korelasyon içinde olduğu tek veri hasta kilosuydu. Sadece erken post-operatif dönemde bu korelasyon gözlemlendi. Dördüncü saatteki ve 24. saatteki VAS skorunda iyileşme sırasıyla %28 ve %31'dir. Sadece 3 hastada post-operatif izlemde bulantı oldu ve bu hastalardan biri kustu. Bunun dışında hastalarda ciddi bir komplikasyon görülmedi. Bütün hastalar epidural anestezi prosedüründen memnun olduklarını ve ileride benzer bir durumunda tekrar aynı anestezi yöntemini tercih edebileceklerini bildirdiler. sONuÇ: Elektif lomber mikrodiskektomi cerrahisinde epidural anestezi, güvenli ve etkili bir yöntemdir.

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A Prospective Randomized Study Comparing Perioperative Outcome Variables After Epidural or General Anesthesia for Lumbar Disc Surgery

Cited by 72 publications

References 24 publications

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

Epidural anesthesia in elective lumbar microdiscectomy surgery: is it safe and effective?

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