S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study

Seyed Masoud Hashemi; Shima Rajaei; Mani Falsafi; Ebrahim Golmakani; Faranak Behnaz; Alireza Zali; Sogol Asgari

doi:10.5812/aapm-131746

S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study

Anesth Pain Med. 2023 Jul 15;13(4):e131746. doi: 10.5812/aapm-131746. eCollection 2023 Aug.

Authors

Seyed Masoud Hashemi^{1

2}, Shima Rajaei^{1

2}, Mani Falsafi^{3

4}, Ebrahim Golmakani^{5

6}, Faranak Behnaz^{1

7}, Alireza Zali^{7

8

9}, Sogol Asgari¹⁰

Affiliations

¹ Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
⁴ Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.
⁵ Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
⁶ Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
⁷ Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸ Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁹ Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹⁰ Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable.

Objectives: This study investigated the efficiency of the S1 transforaminal epidural block.

Methods: This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients.

Results: Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc.

Conclusions: The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.

Keywords: Discectomy; Epidural; Low Back Pain; Lumbar Disc Herniation; Minimally Invasive Spine Surgery; Percutaneous Transforaminal Endoscopic Discectomy; Radiculopathy.