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

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.