Anesthesie locoregionale pour cure microchirurgicale des hernies discales lombaires

ABSTRACT

Goal of the study Lumbar micro discectomy surgery is already performed under spinal anesthesia [SA] in many institutions. The aim of this study is to compare the quality of analgesia and recovery after SA when compared to general anesthesia [GA] after lumbar microdiscectomy surgery. methods: Following light sedation, SA is performed with the patient in the left lateral decubitus position, one to two levels above the herniated disc level. Isobaric 0.5% bupivacaine 3-3.5 ml was injected intrathecally followed by wound infiltration with 15 ml of bupivacaine with 1/200 000 epinephrine prior to surgical incision. Despite randomization, we found significantly more females in the GA group. Pain scores at 4 and 8h postoperatively were lower in SA group as well as total analgesic consumption during the first 24 h. Postoperative recovery including time to drinking, eating and walking were more rapid after SA when compared to GA. During the postoperative period, the incidence of urinary retention was comparable between groups but the occurrence of postoperative nausea and vomiting was significantly higher in the GA group. Moreover, the overall patient's and surgeon's satisfaction were significantly better in the SA group. SA associated to wound infiltration using bupivacaine is an interesting alternative to general anesthesia for outpatient lumbar microdiscectomy surgery