Local Anesthesia With 1% Lidocaine Versus General Anesthesia for Percutaneous Endoscopic Interlaminar Discectomy at L5/S1 Disc Herniation

Study Design: A prospective randomized clinical trial. Objective: In this study, we compared local anesthesia with 1% lidocaine (LA) and general anesthesia (GA) utilized in PEID at L5/S1 disc herniation. Summary of Background Data: Given the anatomic characteristics of L5/S1 segment, interlaminar approach was preferred to perform endoscopic discectomy for L5/S1 disc herniation. Typically, general anesthesia was used for interlaminar approach. However, with general anesthesia, nerve damage during surgery due to being unable to monitor patient status is a main concerned for surgeons. As an alternative option, local anesthesia has been developed recently. But, the optimal type of anesthesia for PEID remains controversial. Methods: From March 2021 to March 2023, 103 consecutive patients with L5/S1 disc herniation who planned to undergo PEID in our unit were randomized to the LA group (n=53) or GA group (n=50). Both groups were followed up for at least 24 months. Surgical-related parameters, clinical outcomes, and complications were compared between the 2 groups. Results: The mean operative time and bed rest time were shorter in the LA group than in the GA group (both P <0.001). The estimated blood loss in the LA group was greater than that in the GA group ( P <0.001). The cost of hospitalization in the LA group was significantly lower than that in the GA group ( P <0.001). At every time point of follow-up, there was no significant difference between the 2 groups in terms of VAS, ODI, and modified MacNab criteria. The satisfaction surveys showed that more patients in the LA group would choose contrary anesthesia, including 6 patients who were administered extravenously injected sufentanil intraoperatively due to intensive pain. Postoperative neuropathic abnormalities were rarer in the LA group. Conclusions: Both local anesthesia using 1% lidocaine and general anesthesia are effective and safe for PEID at the L5/S1 segment. The use of local anesthesia is preferable due to its associated reductions in operative time, bed rest duration, and economic costs.