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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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Wang S, Zheng L, Ma JX, Wang H, Wang KQ, Chen Y, Yu HL, Xiang LB. Comparison of 2 Anesthetic Methods for Transforaminal Endoscopic Lumbar Discectomy: A Prospective Randomized Controlled Study. Global Spine J 2023:21925682231220550. [PMID: 38062746 DOI: 10.1177/21925682231220550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES To compare the effect and safety of 2 anesthetic methods using in the operation of Transforaminal Endoscopic Lumbar Discectomy. METHODS From the January of 2020 to the December of 2021, 230 consecutive patients that underwent TELD were applied with two methods of anesthesia. All the patients were divided into two groups. The Monitored Anesthesia Care (MAC) group used the local anesthesia (LA) with MAC that based on the combination of dexmedetomidine and butorphanol tartrate. The LA group used the local anesthesia only. Then the Visual Analogic Scale (VAS) through the operating period was compared between the two groups at the time points of before operation (T0), inserting of the puncture needle (T1), establishing of the working cannula (T2), excision of the fibrous rings (T3) and immediately postoperatively (T4). Also, the satisfaction degree of the patients for the course of the operations and the occurrence of the complications were compared between the two groups. RESULTS There were no differences of the VAS around the operating area at the time point of T0. Then the MAC group expressed lower scores at all other points of T1, T2, T3 and T4. Then the satisfaction degree of the MAC group was superior than the LA group. No difference was observed for the occurrence of the complications. CONCLUSIONS MAC based on the combination of dexmedetomidine and butorphanol tartrate is an ideal method of anesthesia for TELD with enough effect and safety.
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Affiliation(s)
- Shuang Wang
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Jun-Xiong Ma
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Hong Wang
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Kai-Qiang Wang
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu Chen
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Hai-Long Yu
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopaedics, General Hospital of Northern Theatre Command, Shenyang, China
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Zheng B, Guo C, Xu S, Li H, Wu Y, Liu H. Anesthesia methods for full-endoscopic lumbar discectomy: a review. Front Med (Lausanne) 2023; 10:1193311. [PMID: 37663652 PMCID: PMC10469954 DOI: 10.3389/fmed.2023.1193311] [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: 03/24/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Full-endoscopic lumbar discectomy under local anesthesia is major trends for the treatment of lumbar disc herniation in spine minimally invasive surgery. However, sometimes local anesthesia is not enough for analgesic in surgery especially in interlaminar approach. This study summarizes the current study of anesthesia methods in full-endoscopic lumbar discectomy. Local anesthesia is still the most common anesthesia method in full-endoscopic lumbar discectomy and the comparison group for other anesthesia methods due to high safety. Compared to local anesthesia, Epidural anesthesia is less applied in full-endoscopic lumbar discectomy but reports better intraoperative pain control and equivalent safety due to the motor preservation and pain block characteristic of ropivacaine. General anesthesia can achieve totally pain block during surgery but nerve injury can not be ignored, and intraoperative neuromonitoring can assist. Regional anesthesia application is rare but also reports better anesthesia effects during surgery and equivalent safety. Anesthesia methods for full-endoscopic lumbar discectomy should be based on patient factors, surgical factors, and anesthesiologist factors to achieve satisfactory anesthesia experience and successful surgery.
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Affiliation(s)
- Bin Zheng
- Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Chen Guo
- Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuai Xu
- Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Haoyuan Li
- Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Yonghao Wu
- Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Haiying Liu
- Spine Surgery, Peking University People's Hospital, Beijing, 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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Yue L, Zhang F, Mu G, Shang M, Lin Z, Sun H. Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial. Spine J 2023; 23:954-961. [PMID: 36931566 DOI: 10.1016/j.spinee.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND CONTEXT Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD. PURPOSE This study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine. STUDY DESIGN A double-blind, randomized, placebo-controlled trial. TRIAL REGISTRATION ChiCTR2000039842 (www.chictr.org.cn). SAMPLE Ninety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine. OUTCOME MEASURES The primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients' satisfaction with anesthesia; adverse events; and radiographic outcomes. METHODS Patients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM. RESULTS The overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09-64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient. CONCLUSION The addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.
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Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Feng Zhang
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Guanzhang Mu
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing,100034, China
| | - Zengmao Lin
- Department of Anesthesiology, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, 8th Xishuku Ave, Xicheng District, Beijing, 100034, China.
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Han L, Li T, Chen L, Guo Y, Zhao L, Hu J, Wang L. Effect of Collagenase Chemonucleolysis on Residual Pain After Transforaminal Lumbar Endoscopic Discectomy. J Pain Res 2023; 16:1257-1265. [PMID: 37082440 PMCID: PMC10112479 DOI: 10.2147/jpr.s402534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose To investigate the short-term clinical effect of collagenase chemonucleolysis (CCNL) in the treatment of residual pain after transforaminal lumbar endoscopic discectomy (TLED). Patients and Methods The clinical data of 40 patients with residual pain after TLED for lumbar disc herniation (LDH) in our hospital from January 2018 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) and quality of recovery-15 (QoR-15) were used to evaluate the effect of the operation. Modified MacNab method was used to evaluate the efficacy of CCNL at 6 months and 12 months after operation. Results All patients successfully completed the operation without serious complications, such as intervertebral space infection, vascular injury and nerve injury. The VAS 3 days after TLED was not significantly lower than that Pre-TLED (P > 0.05). The VAS at each time point after CCNL was significantly lower than that at Pre-TLED, and the QoR-15 score at each time point after CCNL was significantly higher than that 3 days after CCNL (P < 0.05). The modified MacNab criteria for the last follow-up was 95%. Conclusion CCNL can effectively relieve the residual pain after TLED, and the quality of life of patients after TLED is improved with time, and the safety of CCNL is higher.
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Affiliation(s)
- Liuhu Han
- AnHui Medical University, HeFei, People’s Republic of China
| | - Tingting Li
- AnHui Medical University, HeFei, People’s Republic of China
| | - Liyang Chen
- AnHui Medical University, HeFei, People’s Republic of China
| | - Yuyu Guo
- AnHui Medical University, HeFei, People’s Republic of China
| | - Long Zhao
- Department of Pain, The First Affiliate Hospital of AnHui Medical University, Hefei, People’s Republic of China
| | - Jun Hu
- Department of Pain, The First Affiliate Hospital of AnHui Medical University, Hefei, People’s Republic of China
| | - Likui Wang
- Department of Pain, The First Affiliate Hospital of AnHui Medical University, Hefei, People’s Republic of China
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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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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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VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy? Pain Res Manag 2022; 2022:5337483. [PMID: 35391853 PMCID: PMC8983264 DOI: 10.1155/2022/5337483] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
Objectives To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. Summary of Background Data. The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult. Methods Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure. Results 131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower (p < 0.001) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; p < 0.001) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; p < 0.001), the lowest with NRS-B (rs = 0.319; p < 0.001). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly (p < 0.001) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment. Conclusion The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature. Am J Sports Med 2021; 49:3234-3241. [PMID: 34491150 DOI: 10.1177/03635465211032612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. PURPOSE To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. RESULTS Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. CONCLUSION PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Zhang L, Chang T, Xu Y, Jing Q, Zhao X, Li C. Epidural Anesthesia With Low Concentration Ropivacaine and Sufentanil for Percutaneous Transforaminal Endoscopic Discectomy: A Randomized Controlled Trial. Front Med (Lausanne) 2020; 7:362. [PMID: 32850885 PMCID: PMC7411122 DOI: 10.3389/fmed.2020.00362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/15/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction: Percutaneous transforaminal endoscopic discectomy is a simple and effective treatment for lumbar intervertebral disc herniation, and local anesthesia is often applied in this kind of surgery in many developing countries, including China. However, many patients still feel excruciating pain under this condition. Epidural anesthesia with low-concentration ropivacaine has no impact on muscle strength, and patients might follow the surgeon well during operation. We hypothesize that epidural anesthesia is feasible for percutaneous transforaminal endoscopic discectomy. Methods: Two hundred patients with disc herniation who underwent percutaneous transforaminal endoscopic discectomy were randomized to receive either epidural anesthesia or local infiltration anesthesia. Primary outcome measures included the pain score, the cooperation degree, and patients' satisfaction. Mean arterial pressure and heart rate were also recorded. Results: Compared with the local anesthesia group, visual analog scale scores, mean arterial pressure, and heart rate were significantly lower in the epidural anesthesia group (P < 0.05), and patients' satisfaction was higher. There were no significant differences in the total operation time or blood loss between two groups. Conclusions: Epidural anesthesia with low-concentration ropivacaine and sufentanil is safe and effective for percutaneous transforaminal endoscopic discectomy. Clinical Trial Registration:ClinicalTrials.gov, identifier: ChiCTR-IOR-17011768.
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Affiliation(s)
- Lingling Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Chang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yaru Xu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Zhao
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng Li
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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