Background: General anesthesia (GA), which is routinely applied in patients who undergo
percutaneous endoscopic interlaminar lumbar discectomy (PEILD) of L5-S1 disc herniation, is
closely associated with postoperative cognitive dysfunction (POCD) in the elderly. Local anesthesia
(LA) is an alternative pain control protocol that has not yet been fully evaluated.
Objectives: To evaluate the feasibility of LA in PEILD compared with GA.
Study Design: A retrospective study.
Setting: This study took place at the First Affiliated Hospital of Harbin Medical University.
Methods: A total of 120 patients (aged 60-85 years) diagnosed with L5-S1 disc herniation and
with American Society of Anesthesiologists fitness grade I or II between March 2016 and August
2017 were enrolled in the current study. Patients were randomly divided into LA group and GA
group. For LA, 0.25% lidocaine was injected layer-by-layer into skin, subcutaneous tissue, fasciae,
lumbar facet joint, muscle, and ligamentum flavum followed by injection of 1.33% lidocaine into
epidural space; for GA, propofol, sufentanil, and cisatracurium were infused intravenously at 1 to
2 mg/kg, 0.3 µg/kg, and 0.15 mg/kg, respectively. Visual Analog Scale (VAS), Oswestry Disability
Index (ODI), and MacNab Criteria (MNC) evaluated the feasibility of LA as pain control protocol
in comparison to GA before and after operation. The development of POCD was assessed by the
Mini-Mental State Examination 1 and 7 days postsurgery. Feasibility of LA as a pain control protocol
was also evaluated by patient’s willingness to receive the same surgical procedure immediately
and 24 hours after the surgery, and intraoperative fluoroscopy use, blood loss, surgery duration,
postoperative bed confinement, and duration and cost of hospital stay were also evaluated.
Results: Patients in both LA and GA groups had comparable VAS grade, ODI, and MNC preand post-PEILD, with significant pain reduction after operation. However, POCD developed only
in GA group but not in LA group. In addition, compared with GA, LA group did not require
postoperative bed confinement, had significantly shorter hospital stay, and lower hospital cost. Low
intraoperative VAS grade and willingness to receive the same procedure reflected the acceptance
of LA by patients.
Limitations: The development of POCD was examined only 7 days after operation. The followup should be extended to 3 months and 2 years postoperation.
Conclusions: LA has satisfactory pain control and low-risk of POCD in PEILD and is well accepted
by patients. The benefits of LA are no postoperative bed confinement, faster recovery, shorter
hospital stay, and lower hospital cost.
Evaluation of a no-opioid post-cesarean pain control protocol
