Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study
Abstract Background During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01939-5 |
| _version_ | 1811306483740049408 |
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| author | Wan-Li Feng Jun-Song Yang Dongmei Wei Han-Lin Gong Yong Xi Hui-Qiang Lv Xin-Gang Wang Bin Xia Jian-Min Wei |
| author_facet | Wan-Li Feng Jun-Song Yang Dongmei Wei Han-Lin Gong Yong Xi Hui-Qiang Lv Xin-Gang Wang Bin Xia Jian-Min Wei |
| author_sort | Wan-Li Feng |
| collection | DOAJ |
| description | Abstract Background During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well accepted by most surgeons when performing percutaneous endoscopic lumbar discectomy (PELD) via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient local anesthesia (LA) in patients with L5/S1 disc herniation. Methods This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of local anesthetic compound (LAC) were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), complications, and adverse reactions. Results The intraoperative satisfaction score was consistently over 7, with an average score of 9.3 ± 0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections, or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 h. Conclusions Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications. |
| first_indexed | 2024-04-13T08:45:19Z |
| format | Article |
| id | doaj.art-3d4d76f5d2394aae99d4a686ae36809c |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-13T08:45:19Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-3d4d76f5d2394aae99d4a686ae36809c2022-12-22T02:53:40ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-09-011511710.1186/s13018-020-01939-5Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility studyWan-Li Feng0Jun-Song Yang1Dongmei Wei2Han-Lin Gong3Yong Xi4Hui-Qiang Lv5Xin-Gang Wang6Bin Xia7Jian-Min Wei8Department of Spine Surgery, Baoji City Hospital of Traditional Chinese MedicineDepartment of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityDepartment of Gynecology and Obstetrics, West China Second University Hospital, Sichuan UniversityDepartment of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan UniversityDepartment of Orthopaedics, Tongchuan People’s HospitalDepartment of Spine Surgery, Baoji City Hospital of Traditional Chinese MedicineDepartment of Spine Surgery, Baoji City Hospital of Traditional Chinese MedicineDepartment of Spine Surgery, Baoji City Hospital of Traditional Chinese MedicineDepartment of Spine Surgery, Baoji City Hospital of Traditional Chinese MedicineAbstract Background During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well accepted by most surgeons when performing percutaneous endoscopic lumbar discectomy (PELD) via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient local anesthesia (LA) in patients with L5/S1 disc herniation. Methods This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of local anesthetic compound (LAC) were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), complications, and adverse reactions. Results The intraoperative satisfaction score was consistently over 7, with an average score of 9.3 ± 0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections, or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 h. Conclusions Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications.http://link.springer.com/article/10.1186/s13018-020-01939-5L5/S1 disc herniationPercutaneous endoscopic lumbar discectomyInterlaminar approachLocal anesthesiaEffect |
| spellingShingle | Wan-Li Feng Jun-Song Yang Dongmei Wei Han-Lin Gong Yong Xi Hui-Qiang Lv Xin-Gang Wang Bin Xia Jian-Min Wei Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study Journal of Orthopaedic Surgery and Research L5/S1 disc herniation Percutaneous endoscopic lumbar discectomy Interlaminar approach Local anesthesia Effect |
| title | Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study |
| title_full | Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study |
| title_fullStr | Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study |
| title_full_unstemmed | Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study |
| title_short | Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study |
| title_sort | gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the l5 s1 level a feasibility study |
| topic | L5/S1 disc herniation Percutaneous endoscopic lumbar discectomy Interlaminar approach Local anesthesia Effect |
| url | http://link.springer.com/article/10.1186/s13018-020-01939-5 |
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