LOCAL VERSUS GENERAL-ANESTHESIA FOR LUMBAR PERCUTANEOUS DISKECTOMY

Ninety-two adult patients scheduled for automated percutaneous discect omy (PERC) were assigned to receive either local anesthesia supplement ed with monitored i.v. analgesia (MIVA) or general endotracheal anesth esia (GA-LITE). Patients were examined 1 week post-PERC for the presen ce of new paresthesias, and they completed a questionnaire 6-18 weeks after PERC about changes in their pain. Sixty-four percent of MIVA pat ients and 83% of GA-LITE patients had diminished pain following PERC. Results did not show any difference between the two groups for new par esthesias after PERC. There were no differences in postoperative pain medication requirements, but the GA-LITE group reported more postopera tive nausea, vomiting, and sore throat. GA-LITE patients averaged 1.06 +/- 0.3 h in the recovery room compared with 0.70 +/- 0.3 h for MIVA patients. Although the use of general anesthesia for PERC has been con traindicated because of fear of damaging the nerve root in the sleepin g patient, we conclude that general anesthesia does not increase nerve injuries attributable to instrumentation. However, general anesthesia did cause a higher incidence of minor complications such as nausea, v omiting, and sore throat in the immediate postoperative period than di d MIVA.