OBJECTIVE: To evaluate the feasibility, safety, and perioperative outcomes of spinal anesthesia combined with erector spinae plane block and dexmedetomidine sedation (SES) compared with general anesthesia (GA) in patients undergoing biportal endoscopic lumbar decompression (BELD).
BACKGROUND: Regional anesthesia has shown advantages in spine surgery, including reduced complications and faster recovery. However, spinal anesthesia alone has limitations in duration and patient tolerance during prolonged prone positioning. The erector spinae plane block provides extended analgesia, and dexmedetomidine sedation offers patient comfort without respiratory depression. Evidence regarding the combined application of these techniques for lumbar decompression surgery, especially BELD, is limited.
MATERIALS AND METHODS: This retrospective study included 41 patients who underwent 1- or 2-level BELD between June 2023 and June 2024. Nineteen patients received SES, and 22 patients underwent GA. Outcomes included operative times, hemodynamic parameters, postoperative pain, ambulation timing, hospital stay, and complications.
RESULTS: All SES procedures were completed without conversion to GA. SES was associated with significantly shorter operation times and earlier emergence, improved intraoperative hemodynamic stability, reduced postoperative pain scores (Visual Analog Scale: 0.2 ± 0.7 vs. 2.7 ± 1.4, P < 0.001), earlier ambulation (0.5 ± 0.8 vs. 1.5 ± 0.8 d, P < 0.001), and shorter hospital stay (3.8 ± 1.5 vs. 6.6 ± 3.0 d, P < 0.001). No anesthesia-related complications occurred in the SES group, whereas the GA group experienced several complications, including postoperative nausea and vomiting.
CONCLUSIONS: SES is a feasible and safe anesthetic technique for BELD, offering favorable perioperative outcomes compared with GA. These preliminary results support SES as a promising approach for enhanced recovery protocols in minimally invasive spine surgery. Larger randomized trials are needed to confirm its safety and effectiveness.
STUDY DESIGN: Retrospective case-control study.
LEVEL OF EVIDENCE: Level III.
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