Balancing neurological safety and patient psychology in percutaneous endoscopic lumbar discectomy: a comparison of three anesthetic modalities

This network meta-analysis pooled 17 randomized trials (1682 patients) comparing local, general, and epidural anesthesia for percutaneous endoscopic lumbar discectomy. Compared with local anesthesia, epidural anesthesia gave slightly lower final disability scores (ODI mean difference -1.02, 95% CI -1.99 to -0.06) and lower early pain (VAS -0.83). Epidural and general anesthesia both improved the odds of a positive anesthesia experience versus local. No direct trials compared general with epidural anesthesia, and complication and nerve root injury differences were not statistically significant.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersAnesthetic choice for endoscopic discectomy trades intraoperative neural feedback against patient comfort, and the ODI benefit seen here is about one point, far smaller than typical clinically meaningful thresholds.

Presenting this at rounds? Start here

• ?For a patient with severe anxiety about being awake during spine surgery, how would you counsel them about local versus epidural anesthesia for endoscopic discectomy, given the nerve-safety and comfort tradeoffs?
• ?In which anatomical scenarios (for example foraminal stenosis or a tight working corridor near the exiting root) would you still favor local anesthesia for its real-time patient feedback despite its poorer patient experience?