title: Lumbar microdiscectomy under epidural anesthesia: a comparison study.
abstract: BACKGROUND
  Lumbar microdiscectomy is most commonly performed under general anesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under epidural anesthesia.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of epidural anesthesia in elective lumbar microdiscectomies.
  
  
  METHODS
  A prospective study evaluating the relative morbidities associated with epidural anesthesia and general anesthesia for lumbar microdiscectomy.
  
  
  METHODS
  Forty-three patients scheduled for primary lumbar microdiscectomy. Two cohorts were formed and were studied separately; one observational of all the 43 patients, and a second cohort of 17 patients who agreed to enter in the randomized trial.
  
  
  METHODS
  The clinical outcome was determined by the presence of postoperative pain, the absence of anesthesia-related complications, and the overall postoperative recovery.
  
  
  METHODS
  This was a prospective study. With institutional review board approval, 43 consecutive patients were enrolled in the study. However, only 17 patients agreed to be randomized to receive either general or epidural anesthesia for the procedure; the remaining 26 patients selected the type of anesthesia of their preference. Recorded data for all patients included: age; total surgical time; occurrence of nausea, vomiting, atelectasis, or cardiopulmonary complication; ability to arise out of bed on the day of surgery; and the total number of inpatient hospital days. Postoperative pain and satisfaction were assessed only in the randomized cohort.
  
  
  RESULTS
  There were a total of 43 patients, with a mean age of 38.1 years. The patients undergoing epidural anesthesia were marginally older than those undergoing general anesthesia. The epidural and general anesthetic groups were not different with respect to surgical time, pain assessed with a linear visual analogue scale, hospital stay, or the likelihood of arising out of bed on the day of surgery. There were no major cardiopulmonary complications in either group. Patients with epidural anesthesia had significantly less nausea and vomiting.
  
  
  CONCLUSIONS
  Epidural anesthesia as an alternative to general anesthesia has shown less postoperative nausea and vomiting in lumbar microdiscectomy. Nevertheless, given the small number of patients, this study should be considered as preliminary, showing small differences in minor potential complications.
authors.affiliation: Spine Surgery, Spine Service, Hospital for Special Surgery, New York, NY 10021, USA.
authors.forename: Elias C
authors.initials: EC
authors.lastname: Papadopoulos
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
authors.forename: Andrew
authors.initials: A
authors.lastname: Sama
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Pappou
authors.forename: Michael K
authors.initials: MK
authors.lastname: Urban
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies