Abstract
Dear Editor
Recently, we had the pleasure of reading “Comparison of 2 Anesthetic Methods for Transforaminal Endoscopic Lumbar Discectomy: A Prospective Randomized Controlled Study” by Wang et al, 1 This retrospective study included 230 patients who underwent transforaminoscopic lumbar discectomy with dexmedetomidine plus butorphanol tartrate and lidocaine alone as a local anesthetic. The efficacy and safety of the two anesthesia methods in transforaminal endoscopic lumbar disc removal were studied by comparing the pain scores, surgical satisfaction and postoperative complications of specific nodes in the two groups. The results showed that dexmedetomidine combined with butorphanol tartrate was an ideal anesthetic method for transforaminoscopic lumbar discectomy, with sufficient efficacy and safety. We are very grateful for the authors’ contributions, but there are still several questions that need to be studied
First of all, how to obtain immediate intraoperative feedback and satisfactory surgical experience during transforaminoscopic lumbar discectomy under local anesthesia is still a question worth discussing. Yang’s retrospective study concluded that local anesthesia combined with conscious sedation is a safe and effective method, 2 and in this experimental design, not only did the individual drug group and more detailed time nodes be added, but also some outcome indicators such as intraoperative vital signs and functional scores were also improved, and the effect and safety of intraoperative drug anesthesia drugs were further evaluated, which we believe is worth learning.
Second, Seiji et al analyzed the risk factors for additional intravenous medication during transforaminoscopic lumbar discectomy under local anesthesia and concluded that older age (>62 years) and lower herniated disc height (Patients <8.2 mm) were significantly associated with the need for additional intravenous drug therapy, 3 requiring close monitoring for changes in vital signs or increased pain. Although there was no significant difference in age and degree of disc herniation between the two groups in this study. However, we hope that the authors can carefully consider the effects of age and disc herniation height on patients’ intraoperative medications, and that stratified statistics can make the study more rigorous.
Finally, the maintenance intravenous dose of dexmedetomidine in this study was related to body weight and surgeon requirements. Colin et al’s model fully describes the potential hemodynamic side effects and bradycardia induced by dexmedetomidine. 4 The meta-analysis by Niu et al also showed that dexmedetomidine intravenous administration increased the risk of bradycardia, 5 and although there were no serious complications in either group in this study, we believe that a multicenter, large-sample, long-follow-up prospective controlled trial can provide a safer and more standardized regimen for intraoperative medication, which is worthy of further study.
In conclusion, the work of Wang et al has made a valuable contribution to the ideal anesthetic method for transforaminoscopic lumbar discectomy. Addressing the above questions can further enrich this research and provide reliable insights for clinical application and patient satisfaction. Once again, we thank the authors for their contributions and hope that the authors will refer to our comments to make further improvements.
