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

Akakın, Akın; Yılmaz, Baran; Akay, Alp; Şahi̇n, Soner; Ekşi, Murat Şakir; Konya, Deniz

doi:10.5137/1019-5149.jtn.11549-14.0

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…However, studies in the literature have suggested that the concentration of ropivacaine used plays an important role in the alleviation of pain. 26 Kathuria 27 and Zhu 28 et al separately reported that low concentrations of ropivacaine (0.25% or 0.375%) blocked the sensory nerves without completely blocking the motor nerves, resulting in better efficacy in pain management when used in EA. Previously, with the help of anesthesiologists, we tested concentrations of ropivacaine ranging from 0.1% to 0.375% according to the physical condition of the patients.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation

Kong¹,

Gao²,

Cong³

et al. 2021

JPR

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Purpose: To compare the clinical effects of local anesthesia (LA), general anesthesia (GA) and modified sensation-motion separation anesthesia (MA) in percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of L5/S1 lumbar disc herniation (LDH) for the purpose of guiding junior surgeons. Methods: Eighty-four patients with L5/S1 LDH underwent PEID using three anesthesia methods. Patients in the LA (26), GA (29) and MA (29) groups received a follow-up examination retrospectively. The general parameters, preparation and anesthesia duration, operative duration, recovery time, incidence of complications, ambulation time, length of hospital stay, incidence of severe complications, and reoperation rate were compared, and clinical outcomes were analyzed using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form Health Survey 36 (SF-36). Results: MA demonstrated obvious advantages over the other two methods with respect to operative duration and resulted in a better intraoperative experience than LA. The patients in the MA group required less time in bed postoperatively and shorter hospital stays than those in the GA group. The mean postoperative VAS, ODI and SF-36 scores were significantly better than the preoperative scores in all groups (P<0.05), but no significant differences in these scores were found among the three groups (P>0.05). Three cases (3/29) of nervous disorder occurred in the GA group. Two patients (one in the GA group (1/29) and one in the LA (1/26) group) underwent revision surgery, with a total recurrence rate of 2.4% (2/84). Conclusion: Due to its high safety and good tolerance by patients, MA is a suitable method for spinal surgeons who are inexperienced with PEID in the treatment of L5/S1 disc herniation.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation

Kong¹,

Gao²,

Cong³

et al. 2021

JPR

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“…Patients could also move their lower limbs when the surgeons required to identify nerve injury. On the other hand, literatures have suggested the concentration of ropivacaine played important role in the alleviation of pain 24 . Kathuria 25 and Zhu 26 et.al separately…”

Section: Discussionmentioning

confidence: 99%

Application of Percutaneous Endoscopic Interlaminar Discectomy (PEID) with Modified Sensation-Motion Separation Anesthesia in the Treatment of L5-S1 Disc Herniation

Kong¹,

Gao²,

Wang³

et al. 2020

Preprint

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Study Design: A retrospective cohort study.Purpose: To compare the clinical effects of local anesthesia (LA), general anesthesia (GA) and modified sensation-motion separation anesthesia (MA) in percutaneous endoscopic interlaminar discectomy (PEID) for treating L5/S1 lumbar disc herniation (LDH) and guide the junior surgeons.Patients and methods: Eighty-four patients with L5/S1 LDH underwent PEID using three anesthesia methods. Patients in groups LA (26), GA (29) and MA (29) were given a follow-up examination retrospectively. General parameters, preparation and anesthesia time, operation time, recovery time, incidence rate of complications, ambulation time, length of hospital stay, severe complications, and reoperation rate were compared, and clinical outcomes were analyzed using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form Health Survey 36 (SF-36).Results: MA demonstrated obvious advantages over the other two methods in operation time and led a better intraoperative experience than LA. Group MA and LA required less time in bed postoperatively and shorter hospital stays than group GA. The mean postoperative VAS score, ODI score and SF-36 score were significantly better than the preoperative values in all groups (P<0.05), but no significant differences were found among the three groups (P>0.05). Three cases (3/29) of nervous disorder occurred in the GA group. Two cases in the GA (1/29) and LA (1/26) groups were revised among all three groups, with a total recurrence rate of 2.4% (2/84). Conclusions: Modified anesthesia with sensation-motion separation was a suitable method for spinal surgeons who were inexperienced with PEID in the treatment of L5/S1 disc herniation due to its high safety and good patient tolerance.

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“…Epidural anesthesia (EA) is another anesthesia method that allows patients to remain conscious. 11 However, nerve injury occurred in PELD using EA as before. A single-center retrospective analysis found that the incidence of nerve root injury in PELD using EA was 1.2% (5/426); 12 another study reported, an 8.6% (30/233) incidence.…”

Section: Introductionmentioning

confidence: 89%

Determining the Minimum Effective Concentration of Ropivacaine in Epidural Anesthesia for Tolerable Pain in Transforaminal Percutaneous Endoscopic Lumbar Discectomy to Avoid Nerve Injury: A Double-Blind Study Using a Biased-Coin Design

Hu¹,

Li²,

Wang³

et al. 2022

DDDT

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Purpose: Epidural anesthesia (EA) is the main anesthesia method for transforaminal percutaneous endoscopic lumbar discectomy (PELD). Reducing the concentration of ropivacaine can help preserve tactile sensation, allowing patients to provide timely feedback to the surgeons when a nerve root is contacted to avoid nerve injury. Therefore, a 90% effective concentration (EC 90 ) that allows for mild pain [visual analog scale (VAS) score ≤3] while maximizing tactile sensation must be identified. Methods: The concentration of ropivacaine for EA was varied for consecutive patients in this study using a two-stage biased-coin design (BCD) according to the response of the previous patient; the concentration used for the first patient was 0.2%. When the previous patient had a negative response (VAS score >3), the concentration used for the next one was increased by 0.015%. When the previous patient had a positive response (VAS score ≤3), the concentration used for the next one had an 89% probability of remaining the same and an 11% probability of being reduced by 0.015%. The EC 90 of ropivacaine was estimated using isotonic regression, and the 95% confidence interval (CI) was estimated using the bootstrapping method in R. Results: A total of 58 patients were included in the study. The calculated EC 90 was 0.294% [95% CI (0.271%, 0.303%)]. Among 13 patients who reported unintended nerve root contact during the operation, none were found to have irreversible nerve injury after the operation. Conclusion:To preserve maximum tactile sensation, the EC 90 of ropivacaine was 0.294% for patients with allowed mild pain. This concentration could allow for timely feedback when the nerve root is contacted, to avoid nerve injury.

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

Cited by 8 publications

References 13 publications

Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation

Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation

Application of Percutaneous Endoscopic Interlaminar Discectomy (PEID) with Modified Sensation-Motion Separation Anesthesia in the Treatment of L5-S1 Disc Herniation

Determining the Minimum Effective Concentration of Ropivacaine in Epidural Anesthesia for Tolerable Pain in Transforaminal Percutaneous Endoscopic Lumbar Discectomy to Avoid Nerve Injury: A Double-Blind Study Using a Biased-Coin Design

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