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Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series

Acta Neurochirurgica volume 164, pages 1209–1216 (2022)Cite this article

Abstract

Introduction

Percutaneous transforaminal endoscopic discectomy (PTED) is increasing in popularity as a minimally invasive procedure to treat sciatica caused by lumbar disc herniation. The objective of the current study is to evaluate safety of and satisfaction with the use of local anesthesia and conscious sedation during PTED.

Methods

During a 12-month inclusion period, patients were prospectively included in this single center case series. Inclusion criteria consisted of sciatica lasting for at least 6 weeks, which was not responsive to conservative treatment. PTED was performed using dexmedetomidine as sedative and lidocaine as local anesthesia. Measurements included the numeric rating scale (NRS, from 0 to 10) for leg pain, back pain, COMI-back, and NRS for anxiety of anesthesia and perioperative continuously monitored hemodynamics. Furthermore, satisfaction with the sedation was scored by patients, surgeons, and anesthesiologists.

Results

Ninety-two consecutive patients were enrolled. Of all patients, 18.5% had anxiety for undergoing surgery under local anesthesia. All but one patient underwent PTED successfully. There was one case of conversion due to severe, uncontrollable back pain during surgery. Throughout the procedure, hemodynamic parameters showed no clinically relevant change compared to baseline. Anesthesiologic complications were three cases (3.4%) of self-limiting hypoxia and five cases (8.6%) of nausea and/or vomiting. Surgeons and anesthesiologists had a high satisfaction rate (> 87%) with the conscious sedation during the procedure, while satisfaction with sedation was scored 8.4 ± 2.2 by patients.

Conclusions

PTED performed under local anesthesia and conscious sedation is safe and effective to treat sciatica and yields high satisfaction rates from surgeons, anesthesiologists, and patients.

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Data availability

Upon reasonable request.

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Acknowledgements

The authors would like to thank Mr. T.C. Chin-See-Chong, Ms. R. Matawlie, Mr. N. Hendriks, and Mr. I. Voigt for their help with the patient measurements.

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Authors and Affiliations

  1. Department of Neurosurgery, Park MC, Rotterdam, The Netherlands

    Pravesh S. Gadjradj & Jamie R. J. Arjun Sharma

  2. Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY, USA

    Pravesh S. Gadjradj

  3. Department of Neurosurgery, Erasmus MC: University Medical Center, Rotterdam, The Netherlands

    Jamie R. J. Arjun Sharma & Biswadjiet S. Harhangi

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  1. Pravesh S. Gadjradj
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Contributions

Gadjradj: conceptualization, project administration, data curation, writing—original draft preparation. Arjun Sharma: data curation, project administration, writing—original draft preparation. Harhangi: conceptualization, data curation, formal analysis, methodology, resources, supervision, visualization, writing—review and editing.

Corresponding author

Correspondence to Pravesh S. Gadjradj.

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IRB approved: MEC-2016–347.

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Written informed consent of all participants upon inclusion.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Spine degenerative

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Gadjradj, P.S., Arjun Sharma, J.R.J. & Harhangi, B.S. Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series. Acta Neurochir 164, 1209–1216 (2022). https://doi.org/10.1007/s00701-021-05100-x

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