Objective: To compare the efficacy and safety of local anesthesia (LA), epidural anesthesia (EA), and general anesthesia (GA) in percutaneous endoscopic interlaminar discectomy (PEID) using a network meta-analysis.
Methods: The clinical studies of LA, EA and GA for PEID were included by searching CNKI, VIP, Wanfang, SinoMed, PubMed, Embase, Cochrane Library, Web of Science, the search period was from the establishment of the database to July 2024. Statistical analysis was performed using Stata 17.0 software.
Results: Ten studies involving 842 patients were included with 384 patients in the group LA, 166 patients in the group EA, and 292 patients in the group GA. The surface under the cumulative ranking curve (SUCRA) rankings showed that group LA performed best in reducing the incidence of dural or nerve root injury (DNRI) (80.0%) and postoperative dysesthesia (POD) (82.2%), lowering failure or recurrence rates (73.5%), and improving functional outcomes (69.3%), but had low anesthesia satisfaction (11.0%). Group EA excelled in shortening operative time (93.1%) and improving anesthesia satisfaction (76.5%) but had a higher POD risk (0.4%). Group GA was most effective in pain reduction (62.1%) but was associated with longer operative time (9.6%) and higher rates of functional impairment (28.4%) and DNRI (17.9%).
Conclusion: In PEID, LA reduces complications and enhances functional recovery but has low satisfaction. EA is suitable for shortening operative time and improving satisfaction but carries a higher POD risk. GA is optimal for pain control but may prolong operative time and increase complications. |
