Pravesh S Gadjradj1,2, Jamie R J Arjun Sharma3,4, Biswadjiet S Harhangi4. 1. Department of Neurosurgery, Park MC, Rotterdam, The Netherlands. p.gadjradj@erasmusmc.nl. 2. Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA. p.gadjradj@erasmusmc.nl. 3. Department of Neurosurgery, Park MC, Rotterdam, The Netherlands. 4. Department of Neurosurgery, Erasmus MC: University Medical Center, Rotterdam, The Netherlands.
Abstract
INTRODUCTION: Percutaneous transforaminal endoscopic discectomy (PTED) is increasing in popularity as a minimally invasive procedure to treat sciatica caused by lumbar disc herniation. The objective of the current study is to evaluate safety of and satisfaction with the use of local anesthesia and conscious sedation during PTED. METHODS: During a 12-month inclusion period, patients were prospectively included in this single center case series. Inclusion criteria consisted of sciatica lasting for at least 6 weeks, which was not responsive to conservative treatment. PTED was performed using dexmedetomidine as sedative and lidocaine as local anesthesia. Measurements included the numeric rating scale (NRS, from 0 to 10) for leg pain, back pain, COMI-back, and NRS for anxiety of anesthesia and perioperative continuously monitored hemodynamics. Furthermore, satisfaction with the sedation was scored by patients, surgeons, and anesthesiologists. RESULTS: Ninety-two consecutive patients were enrolled. Of all patients, 18.5% had anxiety for undergoing surgery under local anesthesia. All but one patient underwent PTED successfully. There was one case of conversion due to severe, uncontrollable back pain during surgery. Throughout the procedure, hemodynamic parameters showed no clinically relevant change compared to baseline. Anesthesiologic complications were three cases (3.4%) of self-limiting hypoxia and five cases (8.6%) of nausea and/or vomiting. Surgeons and anesthesiologists had a high satisfaction rate (> 87%) with the conscious sedation during the procedure, while satisfaction with sedation was scored 8.4 ± 2.2 by patients. CONCLUSIONS: PTED performed under local anesthesia and conscious sedation is safe and effective to treat sciatica and yields high satisfaction rates from surgeons, anesthesiologists, and patients.
INTRODUCTION: Percutaneous transforaminal endoscopic discectomy (PTED) is increasing in popularity as a minimally invasive procedure to treat sciatica caused by lumbar disc herniation. The objective of the current study is to evaluate safety of and satisfaction with the use of local anesthesia and conscious sedation during PTED. METHODS: During a 12-month inclusion period, patients were prospectively included in this single center case series. Inclusion criteria consisted of sciatica lasting for at least 6 weeks, which was not responsive to conservative treatment. PTED was performed using dexmedetomidine as sedative and lidocaine as local anesthesia. Measurements included the numeric rating scale (NRS, from 0 to 10) for leg pain, back pain, COMI-back, and NRS for anxiety of anesthesia and perioperative continuously monitored hemodynamics. Furthermore, satisfaction with the sedation was scored by patients, surgeons, and anesthesiologists. RESULTS: Ninety-two consecutive patients were enrolled. Of all patients, 18.5% had anxiety for undergoing surgery under local anesthesia. All but one patient underwent PTED successfully. There was one case of conversion due to severe, uncontrollable back pain during surgery. Throughout the procedure, hemodynamic parameters showed no clinically relevant change compared to baseline. Anesthesiologic complications were three cases (3.4%) of self-limiting hypoxia and five cases (8.6%) of nausea and/or vomiting. Surgeons and anesthesiologists had a high satisfaction rate (> 87%) with the conscious sedation during the procedure, while satisfaction with sedation was scored 8.4 ± 2.2 by patients. CONCLUSIONS: PTED performed under local anesthesia and conscious sedation is safe and effective to treat sciatica and yields high satisfaction rates from surgeons, anesthesiologists, and patients.
Authors: Roxana M Grasu; Juan P Cata; Anh Q Dang; Claudio E Tatsui; Laurence D Rhines; Katherine B Hagan; Shreyas Bhavsar; Sally R Raty; Radha Arunkumar; Yury Potylchansky; Ian Lipski; Benjamin A Arnold; Thomas M McHugh; Justin E Bird; Andrea Rodriguez-Restrepo; Mike Hernandez; Keyuri U Popat Journal: J Neurosurg Spine Date: 2018-11-01
Authors: H Breivik; P C Borchgrevink; S M Allen; L A Rosseland; L Romundstad; E K Breivik Hals; G Kvarstein; A Stubhaug Journal: Br J Anaesth Date: 2008-05-16 Impact factor: 9.166
Authors: Pravesh S Gadjradj; Maurits W van Tulder; Clemens M F Dirven; Wilco C Peul; B Sanjay Harhangi Journal: Neurosurg Focus Date: 2016-02 Impact factor: 4.047