Efficacy and safety of epidural anesthesia versus local anesthesia in percutaneous transforaminal endoscopic discectomy: a systematic review and meta-analysis

作者：Bin Zheng, Chen Guo, Xu Shuai, Lin‐Yu Jin, Yanye Hong, Chenjun Liu, Haiying Liu · 发表于：Annals of Palliative Medicine · 年份：2022 · DOI：10.21037/apm-21-3413 · 被引用次数：10 · 研究领域：Anesthesia and Pain Management、Spine and Intervertebral Disc Pathology、Pain Management and Opioid Use

BACKGROUND: For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED. METHODS: The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included stud...