Comparison of spinal anesthesia and local anesthesia in percutaneous interlaminar endoscopic lumbar discectomy for L5/S1 disc herniation: a retrospective cohort study

Abstract

Abstract Background: Interlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for the management of lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited. Methods: The propensity score matching was conducted to ensure comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bedrest duration, VAS for pain at 2 hours postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively. Results: Fifty-six patients were assigned to each group. Significant differences were found between the groups in terms of intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 hours postoperatively, a longer operation time, longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05). Conclusion: The SA for IELD provides superior anesthesia and more stable hemodynamics compared to LA but may increase the risk of postoperative complications.