Comparison of General Anaesthesia and Epidural Anaesthesia in Lumbar Microdiscectomies- A Prospective Comparative Study

Abstract

Introduction: Lumbar Microdiscectomy (LMD) is most commonly performed under General Anaesthesia (GA). Regional techniques are being used more widely now, with Epidural Anaesthesia (EA) being safer than Spinal Anaesthesia (SA). Regional anaesthetic methods are being used increasingly, with EA being less harmful than spinal with respect to cardiac and neurological complications. Aim: To compare the intraoperative and postoperative outcomes of GA and EA in single level lumbar microdiscectomies. Materials and Methods: This prospective comparative study was conducted at a single tertiary care centre between April 2014 to April 2018 and Study was conducted among 40 patients who were posted for single level lumbar microdiscectomies. The patients underwent surgery under group GA and group EA. Intraoperatively, parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Surgical Onset Time (SOT), Surgical Time (ST), Total Operating room Time (TOT) and postoperatively Visual Analog Scale (VAS) for pain, the Total Analgesic Dose (TAD) of fentanyl, Postoperative Nausea and Vomiting (PONV) and the level of satisfaction with regard to pain relief (4-point Likert scale) for the first 24 hours were compared. The data were analysed using Statistical Package for Social Sciences (SPSS) version 18 software. Mean, percentage, student’s t-test, χ2 test, Mann-whitney test and appropriate statistical tests were used. Results: A total of 40 patients were enrolled in the present study with rather similar demographic characteristics in both groups. The SOT was significantly more in the EA group (24.30±2.958 min) when compared to the GA group (14.05±2.259) minutes. However, the ST and TOT did not show much of a difference. Intraoperatively, group GA showed significantly high HR and MAP values when compared to group EA (p<0.001). Postoperatively, VAS for pain and the TAD of fentanyl were found to be significantly lesser in the EA group, when compared to GA group. The incidence of Postoperative Nausea and Vomiting (PONV) was less in EA group. The level of satisfaction with regard to pain relief at the end of first 24 hours was more among patients in EA group. Conclusion: The present study concludes that, EA may be used as an alternative to GA in single level lumbar microdiscectomies.