Анестезия и клинические исследования
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ISSN: 2155-6148
ISSN: 2155-6148
Richa Chandra1, Gaurav Mishra2*, Pranay T. Vaghela3
Background: In the present era, a herniated vertebral disc is the most commonly encountered pathology of spine due to multiple lifestyle factors, most common site being L4-L5, L5-S1. Percutaneous endoscopic discectomy has superseded the traditional open discectomy approach for such cases. Regarding the choice of anesthesia for such procedures, general anesthesia was considered Gold standard. With the advent of COVID-19 pandemic, the regional anesthesia techniques gained popularity for a majority of surgical procedures. A novel concept of segmental spinal anesthesia i.e. blockade of selective dermatomes only essential for surgery, using very low dose of local anesthetics take care of surgical pain with intact leg movements decreasing incidence of inadvertent neurological injury. In the present feasibility study, we utilized an approach of segmental spinal anesthesia for endoscopic discectomy.
Material and methods: This study was conducted at a tertiary care center after approval by the Ethical and Research committee, including 38 patients aged 20 to 70 years with ASA physical status I-II scheduled for endoscopic spine discectomy from April 2020 to November 2022. Subarachnoid block was performed at T12-L1 Level with 27 G Quincke Babcock needle using a midline approach in all the patients. Once the free flow of Cerebrospinal Fluid (CSF) was confirmed, 1 ml of isobaric levobupivacaine with 20 mcg of Fentanyl was administered.
Results: In the present study, 37 patients (97.36%) were satisfied with the anesthesia technique and surgeon also accepted it as safe and feasible. There was a single episode of hypotension in 2 patients (5.26%) which responded well to conventional drugs. Paresthesia was observed in 1 patient (2.63%) with no neurological sequelae.
Conclusion: In conclusion, segmental spinal anesthesia can prove to be a beneficial alternative to other modalities in endoscopic discectomy surgery, providing excellent analgesia, sensory and motor block at targeted dermatomal areas.