Drug Design, Development and Therapy (Jun 2024)
Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury?
Abstract
Bingwei Hu,1,* Xianhui Kang,2,* Cheng Zhou,1 Jie Zhou,1 Weixing Xu,3 Weiguo Ding,3 Zhiying Feng,4 Hongwei Wang1 1Department of Anaesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China; 2Department of Anaesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 3Department of Spine Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China; 4Department of of Pain Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hongwei Wang; Zhiying Feng, Tongde Hospital of Zhejiang Province, Zhejiang Chinese Medical University, No. 234 Gucui Road, Xihu District, Hangzhou, People’s Republic of China, Email [email protected]; [email protected]: Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted.Methods: We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC10), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient’s pain score during surgery.Results: Fifty-four patients were included in this study. The EC10 was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including “tactile sensation”, radiculalgia, and numbness.Conclusion: The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.Keywords: maximum tolerable concentration, epidural anaesthesia, transforaminal percutaneous endoscopic lumbar discectomy, biased-coin design, isotonic regression
