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Local versus general anesthesia for lumbar percutaneous discectomy
P M Bokesch1, F T Huffnagle, C Macauley
1Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts.
Journal of Neurosurgical Anesthesiology
|April 1, 1993
Summary
General anesthesia for percutaneous discectomy (PERC) did not increase nerve injuries but led to more minor complications. Monitored i.v. analgesia (MIVA) offered comparable pain relief with fewer side effects.
Area of Science:
- Anesthesiology
- Neurosurgery
- Minimally Invasive Procedures
Background:
- Percutaneous discectomy (PERC) is a minimally invasive spinal procedure.
- The choice of anesthesia for PERC, specifically general endotracheal anesthesia (GA-LITE) versus monitored intravenous analgesia (MIVA), has been debated due to concerns about nerve root injury.
Purpose of the Study:
- To compare the safety and efficacy of GA-LITE and MIVA in patients undergoing PERC.
- To evaluate postoperative pain, neurological complications, and recovery times associated with each anesthesia type.
Main Methods:
- Ninety-two adult patients undergoing PERC were randomized to receive either GA-LITE or MIVA.
- Postoperative assessments included evaluation for new paresthesias at 1 week and pain changes via questionnaire at 6-18 weeks.
- Recovery room time and incidence of postoperative nausea, vomiting, and sore throat were recorded.
Main Results:
- 83% of GA-LITE patients and 64% of MIVA patients experienced pain reduction post-PERC.
- No significant difference in new paresthesias or postoperative pain medication requirements was observed between groups.
- GA-LITE was associated with a higher incidence of postoperative nausea, vomiting, sore throat, and longer recovery room stays.
Conclusions:
- General anesthesia (GA-LITE) for PERC does not appear to increase the risk of nerve injuries related to instrumentation.
- Monitored intravenous analgesia (MIVA) provides comparable pain relief to GA-LITE for PERC with a lower incidence of immediate postoperative complications.
- MIVA may be a preferable anesthesia option for PERC, considering the reduced side effect profile and faster recovery.