J Minim Invasive Spine Surg Tech.  2024 Jul;9(Suppl 2):S102-S106. 10.21182/jmisst.2024.01319.

Comparison of Intradural Bupivacaine With Epidural Levobupivacaine in Lumbar Endoscopic Spinal Surgery

• Bonome-González C
• Bonome-Roel C
• de Mon-Montoliú J
• Velo A
• García-Calo E
• González-Murillo M

• KMID: 2562255
• DOI: http://doi.org/10.21182/jmisst.2024.01319

Abstract

Objective
In lumbar endoscopic spinal surgery, the choice of a regional anesthetic is important for reducing complications and can affect patient recovery and comfort.
Methods
A retrospective analysis was conducted of 66 lumbar microdiscectomies (LMDs) under epidural anesthesia (EA) (n=45) or intradural anesthesia (IA) (n=21) performed by the same surgeon and anesthesiologist. The choice of regional anesthesia in LMD (epidural or intradural) differs between anesthesiologists, and the most frequently anesthetic method used in LMD is general or IA.
Results
EA may be more reliable than IA, as it enables the surgeon to perform a neurological exploration by requesting the patient to make leg or foot movements during surgery, but few studies have compared these 2 anesthetic methods in LMD. We found that there was a statistically significant difference (p<0.05) between the 2 groups in the postoperative recovery times and in the use of vasopressors during surgery.
Conclusion
We suggest that EA reduces the length of time to ambulate, length of stay in the postanesthesia care unit, and the time until initiation of postoperative rehabilitation. Compared to IA, it offers greater hemodynamic stability and allows neurological exploration during surgery.

Keyword

Locoregional anesthesia; Endoscopy; Endoscopic spine surgery; Anesthesia options; Intrathecal bupivacaine; Epidural levobupivacaine