CHOICE OF ANESTHESIA METHOD FOR TRANSFORAMINAL ENDOSCOPIC DISCECTOMY (TFED)

Abstract

Transforaminal endoscopic discectomy (TPED) is a modern effective method of removing symptomatic hernias in the lumbar spine that cause therapeutically resistant pain syndromes. It gained its popularity due to its safety and minimally invasiveness. To avoid injury to the nervous system, this operation must be performed with the patient's clear consciousness. Combined anesthesia (CA), which combines a local anesthetic with an opioid analgesic and epidural anesthesia (EA), are alternative methods of anesthesia, which allows to maintain adequate speech contact between the surgeon and the patient.

Goals and objectives. Compare the efficacy and side effects of CA and EA during TFED.

Materials and methods. The study included 32 patients operated on for herniated intervertebral discs in the lumbar spine during the period 2019-2020.The patients' age was from 24 to 58 years (43 ± 9.8). Among them there were 22 women (68.75%), men - 10 (31, 25%). In 5 cases (15.6%), TFED was performed at the L3L4 level, in 10 cases (31.2%) at the L4L5 level and in 17 cases (52.2%) at the L5S1 level. All patients were divided into 2 groups: a group with combined anesthesia (CA group) and a group with epidural anesthesia (EA group). The first group included 14 (43.75%) patients, the second - 18 (56.25%) patients. Transforaminal endoscopic discectomy was performed according to the standard Maxmorespine® technique. The results of surgical treatment were determined according to the MacNab criteria. The severity of pain syndrome was assessed according to the visual analogue scale (VAS). The following time frames were chosen: before the intervention, intraoperatively, 1 hour after the intervention and 7 days after the operation. Statistical data were processed by the Statistica-10 program. Side effects such as nausea, vomiting, muscle weakness, dysuria, and arterial hypotension were evaluated. Complications in the form of damage to the meninges and neural structures were taken into account.

Results and discussion. There were no complications in both groups. All patients were discharged from the hospital in satisfactory condition the next day after the operation. According to MacNab criteria, all patients were treated with good (56.25%) and excellent (43.75%) outcomes. The analysis shows that in the EA group the level of intraoperative analgesia was significantly higher, which ultimately resulted in a higher degree of satisfaction with anesthesia in patients. A similar pattern was observed when comparing the severity of postoperative pain. In the EA group, two patients (11%) had transient muscle weakness in the lower extremities, which we regarded as a result of prolonged action of epidural anesthesia in conditions of insufficiently correct sensory-motor separation. 5 patients (28%) in the CA group had complaints of nausea and vomiting, the probable cause of which was a side effect of opioids. Dysuric phenomena were not registered in any of the groups.

Conclusions. EA, in our opinion, is preferable to CA for TFED in the lumbar spine. It has a great analgesic effect and is devoid of the side effects of opioids.

Key words: transforaminal endoscopic discectomy, combined anesthesia, epidural anesthesia, efficacy, side effects