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Siciliano A, Lewandrowski KU, Schmidt SL, Alvim Fiorelli RK, de Carvalho PST, Alhammoud A, Alvim Fiorelli SK, Marques MA, Lorio MP. New Perspectives on Risk Assessment and Anticoagulation in Elective Spine Surgery Patients: The Impact of Ultra-Minimally Invasive Endoscopic Surgery Techniques on Patients with Cardiac Disease. J Pers Med 2024; 14:761. [PMID: 39064015 PMCID: PMC11278134 DOI: 10.3390/jpm14070761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/19/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
The advent of ultra-minimally invasive endoscopic spine surgery, characterized by significantly reduced surgery times, minimal blood loss, and minimal tissue trauma, has precipitated a paradigm shift in the preoperative management of patients with cardiac disease undergoing elective spine procedures. This perspective article explores how these advancements have influenced the requirements for preoperative cardiac workups and the protocols surrounding the cessation of anticoagulation and antiplatelet therapies. Traditionally, extensive cardiac evaluations and the need to stop anticoagulation and antiplatelet agents have posed challenges, increasing the risk of cardiac events and delaying surgical interventions. However, the reduced invasiveness of endoscopic spine surgery presents a safer profile for patients with cardiac comorbidities, potentially minimizing the necessity for rigorous cardiac clearance and allowing for more flexible anticoagulation management. This perspective article synthesizes current research and clinical practices to provide a comprehensive overview of these evolving protocols. It also discusses the implications of these changes for patient safety, surgical outcomes, and overall healthcare efficiency. Finally, the article suggests directions for future research, emphasizing the need for updated guidelines that reflect the reduced perioperative risk associated with these innovative surgical techniques. This discussion is pivotal for primary care physicians, surgeons, cardiologists, and the broader medical community in optimizing care for this high-risk patient population.
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Affiliation(s)
- Alexandre Siciliano
- Department of General and Specialized Surgery, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil; (A.S.); (R.K.A.F.)
| | | | - Sergio Luis Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 21941-901, Brazil;
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil; (A.S.); (R.K.A.F.)
| | | | - Abduljabbar Alhammoud
- Department of Orthopaedic Surgery, University of Arizona College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Stenio Karlos Alvim Fiorelli
- Chefe do Serviço de Angiologia e Cirurgia Vascular do Hospital Universitario Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-250, Brazil;
| | - Marcos Arêas Marques
- Serviço de Angiologia e Cirurgia Vascular, Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro 21941-909, Brazil;
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20550-170, Brazil
| | - Morgan P. Lorio
- Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA;
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Shen F, Pu Y, Lan Z, Fu L, Zhang Y, He S, Huang Z. Comparison of different concentrations of ropivacaine in epidural anesthesia for percutaneous transforaminal endoscopic discectomy: a randomized controlled trial. BMC Anesthesiol 2024; 24:223. [PMID: 38965492 PMCID: PMC11223331 DOI: 10.1186/s12871-024-02588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/30/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND This study investigated the optimal concentration of ropivacaine epidural anesthesia for clinical use in percutaneous transforaminal endoscopic discectomy (PTED) by comparing the effects of different concentrations. METHODS Seventy patients scheduled for their first PTED procedure were enrolled in this randomized controlled trial. Patients were randomized to receive ropivacaine at varying concentrations (0.3% or 0.4%). Primary outcome measures included the numeric rating scale (NRS) and hip extension level (HEL). Secondary outcome measures included intraoperative fentanyl dosage and postoperative complications. RESULTS One patient withdrew due to severe postoperative complications. The remaining 69 patients were allocated to the 0.3% (n = 34) and 0.4% (n = 35) groups, respectively. Baseline characteristics showed no significant differences between the two groups (P > 0.05). The NRS score was significantly lower in the 0.4% group than in the 0.3% group (P < 0.01), whereas the HEL score was significantly higher (P < 0.001). The average fentanyl dose in the 0.4% group was significantly lower than that in the 0.3% group (P < 0.01). Postoperative complications occurred in five and two patients in the 0.3% and 0.4% groups, respectively. CONCLUSION Although 0.4% ropivacaine (20 mL) impacts muscle strength, it does not impede PTED surgery. Given its effective analgesic properties and few postoperative complications, 0.4% ropivacaine can be considered a preferred dose for PTED. TRIAL REGISTRATION This study was registered with the Chinese Clinical Trials Registry (Registration number: ChiCTR2200060364; Registration Date: 29/5/2022) and on chictr.org.cn ( https://www.chictr.org.cn/showproj.html?proj=171002 ).
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Affiliation(s)
- Fengyan Shen
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Yuju Pu
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Zhiming Lan
- Department of Orthopedics, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Lijun Fu
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Yan Zhang
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Shenghua He
- Department of Orthopedics, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China
| | - Zengping Huang
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen, 518033, Guangdong, China.
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Hu B, Kang X, Zhou C, Zhou J, Xu W, Ding W, Feng Z, Wang H. Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury? Drug Des Devel Ther 2024; 18:2357-2366. [PMID: 38915867 PMCID: PMC11194284 DOI: 10.2147/dddt.s451980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted. Methods We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC10), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery. Results Fifty-four patients were included in this study. The EC10 was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness. Conclusion The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.
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Affiliation(s)
- Bingwei Hu
- Department of Anaesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Xianhui Kang
- Department of Anaesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Cheng Zhou
- Department of Anaesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Jie Zhou
- Department of Anaesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Weixing Xu
- Department of Spine Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Weiguo Ding
- Department of Spine Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Zhiying Feng
- Department of of Pain Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hongwei Wang
- Department of Anaesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China
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Yan Y, Zhu M, Cao X, Zhang Y, Zhang X, Xu M, Zhang D. Different approaches to percutaneous endoscopic lumbar discectomy for L5/S1 lumbar disc herniation: a retrospective study. Br J Neurosurg 2024; 38:16-22. [PMID: 33331186 DOI: 10.1080/02688697.2020.1861218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To observe the surgical procedure and outcome of percutaneous endoscopic lumbar discectomy for L5/S1 lumbar disc herniation (LDH) by the interlaminar and transforaminal approach. METHODS A total of 153 patients with L5/S1 LDH who were treated using percutaneous endoscopic transforaminal discectomy (PETD, n = 84) or percutaneous endoscopic interlaminar discectomy (PEID, n = 69) from January 2016 to January 2018 were enrolled in this retrospective study. The time of puncture, operation under the endoscope, total operation and number of fluoroscopy of the two groups were compared. All groups were followed up for two years by using the Oswestry disability index (ODI) and the Visual Analogue Scale (VAS). Additionally, the incidence of complications, reoperation and postoperative low back pain were compared between the two groups. RESULTS There were no significant difference in general information between the two groups. Compared to the PEID group, the PETD group had a decreased operation time under the endoscope and an increased puncture time, total operation time, and the number of fluoroscopy (p < 0.05). The preoperative VAS and ODI scores of the PETD and PEID group were decreased at the last follow-up (p < 0.05). There were no difference in the preoperative or last follow-up VAS and ODI scores, as well as complications, reoperation between the two groups (p > 0.05). The incidence of postoperative low back pain in the PETD group was lower than that in the PEID group (p > 0.05). CONCLUSIONS The two-year clinical outcome of PETD is equal to that of PEID for L5/S1 LDH. Compared to those with PETD, the puncture time, total operation time and radiation exposure are lower with PEID, but the incidence of postoperative low back pain is higher.
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Affiliation(s)
- Yi Yan
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mengye Zhu
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuezhong Cao
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Zhang
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuexue Zhang
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mu Xu
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daying Zhang
- Pain Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Liu Y, Zhang Q, Ji N, Wang J, Li J, Du J, Zhao J, Ouyang P, Qin J, Li H, Wang D. Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery. Front Bioeng Biotechnol 2024; 11:1298914. [PMID: 38260730 PMCID: PMC10800398 DOI: 10.3389/fbioe.2023.1298914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The application prospects of percutaneous endoscopic lumbar discectomy (PELD) as a minimally invasive spinal surgery method in the treatment of lumbar disc herniation are extensive. This study aims to find the optimal entry angle for the trephine at the L4/5 intervertebral space, which causes less lumbar damage and has greater postoperative stability. To achieve this, we conduct a three-dimensional simulated analysis of the degree of damage caused by targeted puncture-based trephine osteotomy on the lumbar spine. Methods: We gathered clinical CT data from patients to construct a lumbar model. This model was used to simulate and analyze the variations in trephine osteotomy volume resulting from targeted punctures at the L4/5 interspace. Furthermore, according to these variations in osteotomy volume, we created Finite Element Analysis (FEA) models specifically for the trephine osteotomy procedure. We then applied mechanical loads to conduct range of motion and von Mises stress analyses on the lumbar motion unit. Results: In percutaneous endoscopic interlaminar discectomy, the smallest osteotomy volume occurred with a 20° entry angle, close to the base of the spinous process. The volume increased at 30° and reached its largest at 40°. In percutaneous transforaminal endoscopic discectomy, the largest osteotomy volume was observed with a 50° entry angle, passing through the facet joints, with smaller volumes at 60° and the smallest at 70°. In FEA, M6 exhibited the most notable biomechanical decline, particularly during posterior extension and right rotation. M2 and M3 showed significant differences primarily in rotation, whereas the differences between M3 and M4 were most evident in posterior extension and right rotation. M5 displayed their highest stress levels primarily in posterior extension, with significant variations observed in right rotation alongside M4. Conclusion: The appropriate selection of entry sites can reduce lumbar damage and increase stability. We suggest employing targeted punctures at a 30° angle for PEID and at a 60° angle for PTED at the L4/5 intervertebral space. Additionally, reducing the degree of facet joint damage is crucial to enhance postoperative stability in lumbar vertebral motion units.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Haopeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Dong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Hashemi SM, Rajaei S, Falsafi M, Golmakani E, Behnaz F, Zali A, Asgari S. S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study. Anesth Pain Med 2023; 13:e131746. [PMID: 38023997 PMCID: PMC10676656 DOI: 10.5812/aapm-131746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. Objectives This study investigated the efficiency of the S1 transforaminal epidural block. Methods This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients. Results Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc. Conclusions The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.
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Affiliation(s)
- Seyed Masoud Hashemi
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Rajaei
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mani Falsafi
- Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
- Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ebrahim Golmakani
- Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faranak Behnaz
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sogol Asgari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bajaj AI, Yap N, Derman PB, Konakondla S, Kashlan ON, Telfeian AE, Hofstetter CP. Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07792-4. [PMID: 37450041 DOI: 10.1007/s00586-023-07792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To better understand how anesthesia type impacts patient selection and recovery in TELD, we conducted a multicenter prospective study which evaluates the differences in perioperative characteristics and outcomes between patients who underwent TELD with either general anesthesia (GA) or conscious sedation (CS). METHODS We prospectively collected data from all TELD performed by five neurosurgeons at five different medical centers between February and October of 2022. The study population was dichotomized by anesthesia scheme, creating CS and GA cohorts. This study's primary outcomes were the Oswetry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, assessed preoperatively and at 2-week follow-up. RESULTS A total of 52 patients underwent TELD for symptomatic lumbar disk herniation. Twenty-three patients received conscious sedation with local anesthesia, and 29 patients were operated on under general anesthesia. Patients who received CS were significantly older (60.0 vs. 46.7, p < 0.001) and had lower BMI (28.2 vs. 33.4, p = 0.005) than patients under GA. No intraoperative or anesthetic complications occurred in the CS and GA cohorts. Improvement at 2-week follow-up in ODI, VAS-back, and VAS-leg was greater in patients receiving CS relative to patients under GA, but these differences were not statistically significant. CONCLUSION In our multicenter prospective analysis of 52 patients undergoing TELD, we found that patients receiving CS were significantly older and had significantly lower BMI compared to patients under GA. On subgroup analysis, no statistically significant differences were found in the improvement of PROMs between patients in the CS and GA group.
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Affiliation(s)
- Ankush I Bajaj
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Natalie Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Peter B Derman
- Texas Back Institute, 6020 West Parker Rd, Plano, TX, 75093, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements. J Pers Med 2023; 13:jpm13030381. [PMID: 36983563 PMCID: PMC10052087 DOI: 10.3390/jpm13030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.
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Wu Z, He J, Cheng H, Lin S, Zhang P, Liang D, Jiang X, Cui J. Clinical efficacy of general anesthesia versus local anesthesia for percutaneous transforaminal endoscopic discectomy. Front Surg 2023; 9:1076257. [PMID: 36684360 PMCID: PMC9852754 DOI: 10.3389/fsurg.2022.1076257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Local anesthesia (LA) is recommended for percutaneous transforaminal endoscopic discectomy(PTED), but satisfactory pain management is not mostly achieved. The goal of this study was to examine the clinical efficacy of PTED for lumbar disc herniation when performed under local anaesthetic vs. general anesthesia (GA). Methods From August 2018 to August 2020, the clinical data of 108 patients treated with PTED were retrospectively evaluated and separated into two groups: LA and GA based on the anesthesia method. General information and clinical outcomes of patients were included. Visual analog scale (VAS) and Oswestry disability index (ODI) were recorded before operation, 1 week after operation, and 1 year after operation. In addition, VAS for back pain and leg pain on the second postoperative day were also recorded. Results We divided the patients into two groups: 72 in LA and 36 in GA. There were no significant differences in gender, age, course of disease, body mass index, surgical segment, duration of operation, intraoperative bleeding, time of fluoroscopy, length of hospital stay, total hospitalization cost reoperation, surgical satisfaction, Macnab satisfaction, complications, preoperative and 1 year postoperatively VAS for back pain and leg pain and ODI, VAS for leg pain on the second day and 1 week postoperatively between the two groups (P > 0.05). VAS for back pain in GA group on the second day postoperatively, as well as the VAS for back pain and ODI at one week postoperatively, were better than those in LA group (P < 0.05). However, the total hospitalization cost in LA group was significantly lower than that in GA group (P < 0.05). Further analysis of different ages in the two groups showed that there were significant differences in the VAS for back pain on the second day postoperatively and ODI at 1 week postoperatively in the middle-aged group (45 ≤ Y ≤ 59), as well as the VAS for back pain on the second day postoperatively in the senior group (Y ≥ 60) (P < 0.05). However, there were no significant difference among other groups (P > 0.05). Conclusion Long-term outcomes were similar for both PTED under LA and GA, while GA group had better short-term outcomes, especially in middle-aged and elderly patients.
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Affiliation(s)
- Zhihua Wu
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahui He
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huantong Cheng
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaohao Lin
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Correspondence: Xiaobing Jiang Jianchao Cui
| | - Jianchao Cui
- Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Correspondence: Xiaobing Jiang Jianchao Cui
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Zhang J, Wang X, Cai Z, Kang J, Liu Y, Nie C, Zhou H. Analgesic effect of epidural anesthesia via the intervertebral foramen approach in percutaneous transforaminal endoscopic discectomy: a retrospective study. BMC Anesthesiol 2022; 22:397. [PMID: 36539695 PMCID: PMC9764488 DOI: 10.1186/s12871-022-01924-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Satisfactory intraoperative analgesia is critical for percutaneous transforaminal endoscopic discectomy (PTED). Local anesthesia (LA) and epidural anesthesia (EA) are recommended for PTED. LA alone does not achieve satisfactory pain management during PTED and other analgesics or sedatives are usually needed. Traditional EA, which involves implanting an epidural catheter through the midline or paramedian, has disadvantages such as difficulty in catheterization and increased preoperative preparation time. Rather than performing conventional EA, we injected local anesthetics through the intervertebral foramen during the puncture process, which we termed lumbar transforaminal EA (LTEA), and observed its feasibility and safety. This study aimed to conduct a comprehensive comparison of differences in analgesia between LA and LTEA in patients with PTED. METHODS We performed a retrospective analysis of patients who underwent PTED between January 2018 and January 2021. Patients were divided into LA and LTEA groups. Data obtained from the electronic medical records included primary outcomes (visual analog scale [VAS] scores and anesthesia satisfaction rate) and secondary outcomes, including vital signs such as heart rate (HR), mean arterial pressure (MAP), total dosage of fentanyl, operation time, X-ray exposure time, Oswestry Disability Index (ODI) scores, and complications. RESULTS In total, 160 patients (80 in each group) were analyzed in this study. The VAS scores for lumbar and leg pain were significantly lower in the LTEA group than in the LA group (P < 0.0001). The anesthesia satisfaction rate was 90.0% in the LTEA group and 72.5% in the LA group (P < 0.005). MAP and HR values in the LTEA group were significantly lower than those in the LA group (P < 0.05). The total dose of fentanyl in the LTEA group was significantly lower than that in the LA group (P < 0.05). As for ODI values, the average operation time, X-ray exposure time, and incidence of complications were not significantly different between the two groups (P > 0.05). CONCLUSIONS LTEA simplifies the process of EA and can achieve a good analgesic effect intraoperatively without increasing the preoperative preparation time; thus, it may be adopted as an alternative mode of anesthesia during PTED surgery.
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Affiliation(s)
- Jingyue Zhang
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China ,grid.412596.d0000 0004 1797 9737Department of Pain Management, the First Affiliated Hospital of Harbin Medical University, No.25 Post Office Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Xueyao Wang
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Zhenhua Cai
- grid.412463.60000 0004 1762 6325Department of Pain Management, the Second Affiliated Hospital of Harbin Medical University, No.246, Xuefu Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Jiyu Kang
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Yongliang Liu
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Chunyan Nie
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China
| | - Huacheng Zhou
- grid.411491.8Department of Pain Management, the Fourth Affiliated Hospital of Harbin Medical University, No.37, Yiyuan Street, Nangang District, Harbin, 150001 Heilongjiang Province China
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Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3523172. [PMID: 36277018 PMCID: PMC9584661 DOI: 10.1155/2022/3523172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
Objective. Combined spinal epidural anesthesia (CSEA) is applied to lower limb orthopaedic surgery in the elderly. This study is aimed at exploring the effect of CSEA in orthopaedic surgery of elderly patients. Methods. A total of 40 elderly patients with femoral fracture needing hip replacement or femoral head replacement in our hospital from June 2021 to June 2022 were selected as the research objects. The subjects were divided into observation group (
) and control group (
) by random number table method. The control group was given epidural anesthesia, while the observation group was given CSEA. Hemodynamic indexes (heart rate (HR) and mean arterial pressure (MAP)), visual analogue scale (VAS) pain score changes, anesthetic effects, and postoperative complications were compared between the two groups. Results. After operation, the observation group had lower HR and MAP values than the control group (
). The dosage of local anesthetics in the observation group was significantly less than that in the control group (
). The onset time and improvement time of sensory block in the observation group were significantly faster than those in the control group (
). The observation group had a lower VAS score than the control group (
). There was no significant difference in Bromage score or incidence of complications between the two groups (
). Conclusion. The use of CSEA has good anesthetic effect. It has the disadvantage of no headache after traditional spinal anesthesia, is not limited by time, and can be used for postoperative analgesia, which is more suitable for the anesthesia of lower limb orthopaedic surgery in the elderly.
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Zhen Z, Zhao J, Chen C, Sun X, Zhang B, Yang Q. Comparing the Effectiveness and Safety Between Local Anesthesia versus Epidural Anesthesia for Percutaneous Transforaminal Endoscopic Discectomy: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 166:e528-e535. [PMID: 35853571 DOI: 10.1016/j.wneu.2022.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to compare the effectiveness and safety of local anesthesia (LA) and epidural anesthesia (EA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making. METHODS We searched PubMed, EMBASE, the Cochrane library, Web of Science, Medline, Science Direct, and China National Knowledge Infrastructure from inception to March 2022 to identify randomized and nonrandomized controlled trials comparing LA and EA for PTED. Studies that assessed at least 2 of the following indicators were considered eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale scores for pain, Oswestry Disability Index, and complications. Meta-analysis was conducted using Review Manager 5.3.3 software. RESULTS Five randomized controlled trials and 5 retrospective cohort studies involving a total of 1660 patients were included. The LA and EA groups included 803 and 857 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative lumbar visual analog scale scores (P < 0.00001) and anesthesia satisfaction rate (P < 0.00001). There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative Oswestry Disability Index, and complication rate. CONCLUSIONS EA is as safe as LA and produces better anesthetic effects than LA in patients undergoing PTED. Therefore, EA should be promoted as a reliable anesthetic technique for PTED.
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Affiliation(s)
- Zhilong Zhen
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China; Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jianmin Zhao
- Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Chao Chen
- Tianjin Hospital Tianjin University, Tianjin, China
| | - Xun Sun
- Tianjin Hospital Tianjin University, Tianjin, China
| | - Bo Zhang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China; Tianjin Hospital Tianjin University, Tianjin, China
| | - Qiang Yang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China; Tianjin Hospital Tianjin University, Tianjin, China.
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Xie K, Wang YL, Teng WB, He R, Li YH, Huang SQ. The Median Effective Concentration (EC 50) of Epidural Ropivacaine With Different Doses of Oxycodone During Limb Surgery in Elderly Patients. Front Med (Lausanne) 2022; 8:808850. [PMID: 35127764 PMCID: PMC8814631 DOI: 10.3389/fmed.2021.808850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background Oxycodone can be used both intravenously and epidurally in elderly patients because of its strong analgesic effect and more slight respiratory inhibition compared with other opioids at the same effect. In this study, we determined the median effective concentration (EC50) of epidural ropivacaine required for great saphenous vein surgery in elderly patients in order to describe its pharmacodynamic interaction with oxycodone. Methods One hundred forty-one elderly patients scheduled for high ligation and stripping of the great saphenous vein surgery were allocated into three groups in a randomized, double-blinded manner as follows: Q2.5 group (2.5 mg oxycodone), Q5.0 group (5.0 mg oxycodone), and C group (normal saline). Anesthesia, was achieved with epidural ropivacaine and oxycodone. The EC50 of ropivacaine for surgery with different doses of oxycodone was adjusted by using an up-and-down sequential methods with an adjacent concentration gradient at a factor of 0.9 to inhibit analgesia. Anesthesia associated adverse events and recovery, characteristics were also recorded. Results The EC50 of ropivacaine for the great saphenous vein surgery in elderly patients was 0.399% (95% CI, 0.371–0.430%) in the Q2.5 group, 0.396% (95% CI, 0.355–0.441%) in the Q5.0 group, and 0.487% (95% CI, 0.510–0.465%) in the C group, respectively (P < 0.05). Specially, the EC50 of ropivacaine in the Q2.5 and Q5.0 groups was lower than that in the C group (P < 0.01), But the difference between the Q2.5 group and the Q5.0 group was not significant (P > 0.05). There was no significant difference in the Bromage score from the motor block examination, heart rate (HR) or mean arterial pressure (MAP) at each observation time point after epidural administration among the three groups (P > 0.05). No serious adverse reactions occurred in any of the three groups. Conclusion Oxycodone combined with ropivacaine epidural anesthesia can reduce the EC50 of ropivacaine required for elderly patients undergoing the great saphenous vein surgery. There was no significant difference in anesthesia associated adverse events among the three groups. The recommended dose of oxycodone is 2.5 mg.
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Affiliation(s)
- Kai Xie
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yu-Long Wang
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Wen-Bin Teng
- Department of Anesthesiology, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Rui He
- Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yu-Hong Li
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Su-Qin Huang
- Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
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Hu B, Li L, Wang H, Ma T, Fu Z, Kang X, Feng Z. 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. Drug Des Devel Ther 2022; 16:315-323. [PMID: 35173415 PMCID: PMC8841299 DOI: 10.2147/dddt.s334605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/21/2021] [Indexed: 01/09/2023] Open
Abstract
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 (EC90) 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 EC90 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 EC90 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 EC90 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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Affiliation(s)
- Bingwei Hu
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Liang Li
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Hongwei Wang
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Tingting Ma
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhimei Fu
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Xianhui Kang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhiying Feng
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Zhiying Feng; Xianhui Kang, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People’s Republic of China, Email ;
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15
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Hu B, Wang H, Ma T, Fu Z, Feng Z. Effect Analysis of Epidural Anesthesia with 0.4% Ropivacaine in Transforaminal Endoscopic Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2929843. [PMID: 34659682 PMCID: PMC8514919 DOI: 10.1155/2021/2929843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
Background Epidural anesthesia used in percutaneous endoscopic lumber discectomy (PELD) has the risk of complete neurotactile block. Patients cannot timely respond to the operator when the nerve is touched by mistake, so the potential risk of nerve injury cannot be avoided. According to pharmacodynamics, with the decrease of local anesthetic concentration, the nerve tactile gradually recovered; however, the analgesic effect also gradually weakened. Therefore, it is necessary to explore an appropriate concentration of local anesthetics that can keep the patients' nerve touch without pain. By comparing the advantages and disadvantages of 0.4% ropivacaine epidural anesthesia, local anesthesia and intravenous anesthesia on intraoperative circulation fluctuation, the incidence of salvage analgesia and the incidence of nerve non-touch, the feasibility of using low concentration epidural anesthesia in PELD to obtain enough analgesia and avoid the risk of nerve injury was confirmed. Methods 153 cases of intervertebral foramen surgery from October 2017 to January 2020 were selected and divided into local anesthesia group (LA group), 0.4% ropivacaine epidural anesthesia group (EA group), and intravenous anesthesia group (IVA group) according to different anesthesia methods. The changes of blood pressure and heart rate, the incidence of rescue analgesia and nerve root non-touch were compared among the three groups. Results The difference of map peak value among the three groups was statistically significant (P < 0.001); pairwise comparison showed that the map peak value of the LA group was higher than that of the EA group (P < 0.001) and IVA group (P < 0.001), but there was no statistical significance between the EA group and IVA group. The difference of HR peak value among the three groups was statistically significant; pairwise comparison showed that the HR peak value of the LA group was higher than that of the EA group (P < 0.001) and IVA group (P < 0.001), but there was no statistical significance between the EA group and IVA group. There was significant difference in the incidence of intraoperative hypertension among the three groups (P < 0.05); pairwise comparison showed that the incidence of intraoperative hypertension in the EA group was lower than that in the LA group (P < 0.05), while there was no significant difference between the IVA group, EA group, and LA group. There was significant difference in the incidence of rescue analgesia among the three groups (P < 0.01); pairwise comparison showed that the incidence of rescue analgesia in the EA group was lower than that in the LA group (P < 0.05) and IVA group (P < 0.05), but there was no significant difference between the LA group and IVA group. Due to the different analgesic mechanisms of the three anesthesia methods, local anesthesia and intravenous anesthesia do not cause the loss of nerve tactile, while the incidence of nerve tactile in 0.4% ropivacaine epidural anesthesia is only 2.4%, which is still satisfactory. Conclusion Epidural anesthesia with 0.4% ropivacaine is a better anesthesia method for PELD. It not only has a low incidence of non-tactile nerve, but also has perfect analgesia and more stable intraoperative circulation.
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Affiliation(s)
- Bingwei Hu
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Hongwei Wang
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Tingting Ma
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Zhimei Fu
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Zhiying Feng
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Kong M, Gao C, Cong W, Li G, Zhou C, Ma X. Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation. J Pain Res 2021; 14:2039-2048. [PMID: 34267548 PMCID: PMC8275187 DOI: 10.2147/jpr.s306319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
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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Affiliation(s)
- Meng Kong
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province, 266000, People's Republic of China
| | - Changtong Gao
- Minimally Invasive Interventional Therapy Center, Qingdao Municipal Hospital, Qing'dao, Shandong Province, 266000, People's Republic of China
| | - Wenbin Cong
- Department of Radiology, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province, 266000, People's Republic of China
| | - Guanghui Li
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province, 266000, People's Republic of China
| | - Chuanli Zhou
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province, 266000, People's Republic of China
| | - Xuexiao Ma
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province, 266000, People's Republic of China
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He J, Tang J, Jiang X, Ren H, Cui J, Liang Z, Zhang J, Liang D. Efficacy and Safety of Foraminoplasty Performed Using an Endoscopic Drill to Treat Axillary Disc Herniation. World Neurosurg 2020; 138:e413-e419. [DOI: 10.1016/j.wneu.2020.02.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/22/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
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Local anesthetic with sedation is a viable alternative to general anesthesia for lumbar spinal decompressions: A retrospective cohort feasibility study and short-term analysis of outcomes. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ren Z, He S, Li J, Wang Y, Lai J, Sun Z, Feng H, Wang J. Comparison of the Safety and Effectiveness of Percutaneous Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation Under Epidural Anesthesia and General Anesthesia. Neurospine 2020; 17:254-259. [PMID: 32054145 PMCID: PMC7136111 DOI: 10.14245/ns.1938366.183] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous endoscopic lumbar discectomy (PELD) under epidural anesthesia (EA) and general anesthesia (GA) for treating lumbar disc herniation (LDH). METHODS A retrospective study involving 86 patients with LDH managed by PELD under EA and GA was conducted from July 2018 to March 2019. These patients were divided into 2 groups according to the type of anesthesia. Patient's demographics data as well as the operation time, complications, fluoroscopy shots, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and MacNab scores of the 2 groups were recorded. All of the patients were followed-up at 6 months after operation. RESULTS There were no significant differences were detected in the preoperative demographics between the groups (p > 0.05). Two cases (4.8%) under GA developed transient motor weakness, 3 cases (7.4%) presented numbness of lower limb, and 1 case (2.4%) had cauda equina syndrome after operation. In EA group, 1 case (2.2%) had motor weakness and 3 cases (6.7%) had lower limb numbness, which resolved completely at the last follow-up. There was significant difference between preoperative VAS, JOA, and ODI scores and postoperative scores (p < 0.01). Moreover, there were no differences in the operation time, fluoroscopy shots, and MacNab scores between the 2 groups (p > 0.05). CONCLUSION EA and GA in PELD are effective and safe, and no significant difference in complications was observed. Based on our experience, we recommended junior surgeons to perform PELD under EA for getting feedback from the patient to avoid nerve injury and reduce the radiation dose. The concentration of ropivacaine in EA should be considered carefully.
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Affiliation(s)
- Zhiqiang Ren
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shenghua He
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jiao Li
- Department of Paediatrics, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yeguang Wang
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Juyi Lai
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhitao Sun
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Hualong Feng
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jian Wang
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Sun J, Fang C, Gao F, Wei L, Qian J. Comparison of effectiveness and safety between epidural anesthesia vs local anesthesia for percutaneous transforaminal endoscopic discectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18629. [PMID: 31895822 PMCID: PMC6946500 DOI: 10.1097/md.0000000000018629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making. METHODS We searched PubMed, Embase, the Cochrane library, Web of Science, Medline, ScienceDirect, and the China National Knowledge Infrastructure from inception to June 2019 in order to identify randomized and nonrandomized controlled trials comparing EA and LA for PTED. Studies assessing at least 2 of the following indicators were eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), and complications. Two assessors evaluated the quality of the literature using the Cochrane Handbook or Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.3 software. RESULTS Four randomized controlled trials and 4 retrospective cohort studies involving a total of 1000 patients were included. The LA and EA groups included 473 and 527 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative (P < .00001) and postoperative (P < .00001) lumbar VAS scores, intraoperative (P < .00001) and postoperative (P = .001) leg VAS scores, and anesthesia satisfaction rate (P < .00001), with EA being superior to LA in all aspects. There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative ODI, and complication rate. CONCLUSION EA is as safe as LA and produces better anesthetic effects than does LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.
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Affiliation(s)
- Jian Sun
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
| | - Chao Fang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
| | - Fei Gao
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Laifu Wei
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Jun Qian
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
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Zhou Z, Hu S, Zhao YZ, Zhu YJ, Wang CF, Gu X, Fan GX, He SS. Feasibility of Virtual Reality Combined with Isocentric Navigation in Transforaminal Percutaneous Endoscopic Discectomy: A Cadaver Study. Orthop Surg 2019; 11:493-499. [PMID: 31207133 PMCID: PMC6595140 DOI: 10.1111/os.12473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 08/24/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives Transforaminal percutaneous endoscopic discectomy (TPED) is one of the most commonly used minimally invasive spine surgeries around the world. However, conventional surgical planning and intraoperative procedures for TPED have relied on surgeons’ experience, which limits its standardization and popularization. Virtual reality (VR) is a novel technology for pre‐surgical planning in various fields of medicine, while isocentric navigation can guide intraoperative procedures for TPED. The present study aimed to explore the feasibility of applying VR combined with isocentric navigation in TPED on cadavers. Methods The surgical levels were L3/L4 and L4/L5 as well as L5/S1 of both sides of each cadaver specimen. First, the surgeon manually conducted the above procedures on the left side of every specimen without preoperative simulation and isocentric navigation (Group A). Then the same surgeon conducted the VR simulation for surgical planning of the right side (Group B). After VR simulation, the same surgeon made the percutaneous punctures and placed the working channel on the right side of the specimen at all levels. Results At the L3/L4 level, the puncture‐channel time was 11.36 ± 2.13 min in Group A and 11.29 ± 2.23 min in Group B (t = 0.097, P = 0.938). The exposure time was 17.21 ± 2.91 s in Group A and 14.64 ± 1.60 s in Group B (t = 2.534, P = 0.025). At the L4/L5 level, the puncture‐channel time was 13.86 ± 3.90 min in Group A and 11.93 ± 2.95 min in Group B (t = 2.291, P = 0.039). Exposure time was 20.64 ± 3.84 s in Group A and 16.43 ± 2.47 s in Group B (t = 6.118, P < 0.01). There were 7 patients undergoing foraminotomy in Group A and 3 patients undergoing foraminotomy in Group B (t = 2.280, P = 0.236). At the L5/S1 level, the puncture‐channel time was 18.21 ± 1.85 min in Group A and 15.71 ± 3.20 min in Group B (t = 2.476, P = 0.028). Exposure time was 26.07 ± 3.17 s in Group A and 22.50 ± 2.68 s in Group B (t = 2.980, P = 0.011). There were 14 patients receiving foraminotomy in Group A and 13 patients receiving foraminotomy in Group B (t = 1.000, P = 1.000). Conclusions Virtual reality combined with isocentric navigation is feasible in TPED. It enables precise surgical planning and improves intraoperative procedures, and has the potential for application in clinical practice.
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Affiliation(s)
- Zhi Zhou
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Shuo Hu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yong-Zhao Zhao
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yan-Jie Zhu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Chuan-Feng Wang
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xin Gu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Guo-Xin Fan
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Shi-Sheng He
- Orthopaedics Department, Shanghai Tenth People's Hospital, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
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22
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Fan G, Feng C, Yin B, Guan X, Fan Y, Zhu Y, Wang C, He S. Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons. World Neurosurg 2018; 119:e1021-e1028. [PMID: 30142433 DOI: 10.1016/j.wneu.2018.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD. METHODS Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast. RESULTS A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05). CONCLUSIONS The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.
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Affiliation(s)
- Guoxin Fan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chaobo Feng
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bangde Yin
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofei Guan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunshan Fan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanjie Zhu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanfeng Wang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Shisheng He
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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23
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Gu G, Wang C, Gu X, Zhang H, Zhao Y, He S. Percutaneous Transforaminal Endoscopic Discectomy for Adjacent Segment Disease After Lumbar Fusion in Elderly Patients Over 65 Years Old. World Neurosurg 2018; 112:e830-e836. [PMID: 29408425 DOI: 10.1016/j.wneu.2018.01.170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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