经椎板间入路经皮内窥镜下椎间盘切除术治疗L5/S1椎间盘突出症术中应用不同麻醉方式对术后疗效的影响

目的比较经椎板间入路经皮内窥镜下椎间盘切除术(PEID)治疗L5/S1椎间盘突出症术中应用局部麻醉和连续硬膜外麻醉对术后疗效的影响。方法 2012年12月—2015年12月,采用PEID治疗L5/S1椎间盘突出症患者63例,其中31例术中采用1.0%盐酸利多卡因局部浸润麻醉(A组),余32例术中采用0.5%罗哌卡因连续硬膜外麻醉(B组)。记录并比较2组患者术前、末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),以及手术时间、透视时间、术中满意度和并发症发生情况。结果所有手术顺利完成,随访18～24(20.0±2.5)个月。2组患者末次随访时VAS评分、ODI较术前显著改善,差异均有统计学意义(P 0.05),但组间比较差异无统计学意义(P 0.05);2组患者手术时间、透视时间相比差异无统计学意义(P 0.05);B组患者术中满意度明显优于A组,差异有统计学意义(P 0.05);2组均无手术相关并发症发生。结论术中采用局部浸润麻醉或连续硬膜外麻醉不影响PEID治疗L5/S1椎间盘突出症的术后疗效。

Effect of different anesthesia methods on outcomes after percutaneous endoscopic interlaminar discectomy for L5/S1 intervertebral disc herniation

Objective To compare the effects of local anesthesia and continuous epidural anesthesia on postoperative outcomes of percutaneous endoscopic interlaminar discectomy(PEID) for L₅/S₁ intervertebral disc herniation. Methods From December 2012 to December 2015, 63 patients with L₅/S₁ intervertebral disc herniation were treated with PEID. Among them, 31 cases were treated by local infiltration anesthesia with 1.0% lidocaine hydrochloride(group A), and the remaining 32 cases were treated by continuous epidural anesthesia with 0.5% ropivacaine(group B). The visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation and final follow-up, operation time, fluoroscopy time, intraoperative satisfaction and complications were recorded and compared in all the patients. Results All the patients successfully completed the surgery and followed up for 18-24(20.0±2.5) months. At the final follow-up, the VAS score and ODI of the 2 groups were significantly improved compared with those before operation, and the differences were statistically significant(P<0.05), but there was no significant difference between the 2 groups(P>0.05). There was no significant difference between the 2 groups in operation time and fluoroscopy time(P>0.05). Intraoperative satisfaction of the patients in group B was better than that in group A, and the difference was statistically significant(P<0.05). No complications occurred in the 2 groups. Conclusion Intraoperative local infiltration anesthesia or continuous epidural anesthesia does not affect the efficacy of PEID in the treatment of L₅/S₁ intervertebral disc herniation.