Endoscopic-Assisted Peri-Root Anesthesia Provides Superior Intraoperative Analgesia Over Epidural Anesthesia in L5–S1 Interlaminar Endoscopic Discectomy

Hengrui Chang; Yuanqing Niu; Yiwen Zhang; Qi'ao Wu; Jiayuan Sun; Di Zhang; Jiaxin Xu

doi:10.1111/os.70268

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (4) :815 -823. DOI: 10.1111/os.70268

RESEARCH ARTICLE

Endoscopic-Assisted Peri-Root Anesthesia Provides Superior Intraoperative Analgesia Over Epidural Anesthesia in L5–S1 Interlaminar Endoscopic Discectomy

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Abstract

Objective: Interlaminar endoscopic lumbar discectomy, particularly with the Delta large-channel system, offers significant advantages in treating L5–S1 disc herniation. However, intraoperative pain management under local anesthesia remains challenging. Conventional epidural anesthesia (EA) often leads to unpredictable effects and risks such as motor block. This study proposes a novel endoscopic-assisted peri-root anesthesia (PA) technique to improve analgesic precision and safety.

Methods: This retrospective analysis was conducted on 132 patients who underwent interlaminar endoscopic surgery for L5–S1 disc herniation between January 2022 and December 2023. Patients were divided into PA (n = 65) and EA (n = 67) groups. Perioperative outcomes, including intraoperative pain, motor block incidence, operative time, hospital stay, and complications, were compared using the Mann–Whitney U test, chi-squared test, or Fisher's exact test as appropriate. Anesthesia satisfaction and mid-term functional outcomes (VAS and ODI) were also evaluated.

Results: The results showed that the PA group had significantly lower intraoperative pain levels (median VAS: 2 [1, 2] vs. 2 [1, 4], p = 0.005) and no cases of unexpected motor block compared to six cases (9.0%) in the EA group (p = 0.028). Patients in the PA group had 2.12 times higher odds of reporting a better satisfaction score on the Likert scale compared to those in the EA group (OR = 2.12, 95% CI: 1.14–3.95, p = 0.018, logistic regression).

Conclusion: These findings suggest better immediate neurological preservation with the PA technique, but its long-term efficacy and safety profile, particularly regarding rare complications, still require confirmation through larger, prospective randomized controlled trials with extended follow-up.

Keywords

anesthesia / discectomy / endoscopic / epidural / interlaminar / lumbar disc herniation

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Hengrui Chang, Yuanqing Niu, Yiwen Zhang, Qi'ao Wu, Jiayuan Sun, Di Zhang, Jiaxin Xu. Endoscopic-Assisted Peri-Root Anesthesia Provides Superior Intraoperative Analgesia Over Epidural Anesthesia in L5–S1 Interlaminar Endoscopic Discectomy. Orthopaedic Surgery, 2026, 18 (4) : 815-823 DOI:10.1111/os.70268

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