492: Effect of Direct Visual Ventral PLL Anesthetic on Pain in Transforaminal Endoscopic Discectomy

Topic: Clinical Science

Please choose one of the following: Pain category (ICD-11)

Choose one of the following: Other chronic pain category

Please choose one to three of the following: Treatment/management

Background and Aims: Lumbar disc herniation (LDH) is one of the common causes of low back pain. Some patients need surgical intervention after ineffective conservative treatment. Currently, percutaneous transforaminal endoscopic discectomy (PTED) is the main minimally invasive surgical method. However, patients undergoing PTED for LDH frequently experience intolerable pain during the operation. Therefore, this study observed the clinical efficacy and safety of local anesthetic injection into the ventral side of posterior longitudinal ligament (PLL) under endoscopic visualization for alleviating intraoperative pain in PTED.

Methods: This study is a retrospective clinical study. A clinical analysis was conducted on 141 patients undergoing PTED. Patients were divided into two groups: the local anesthetic injection group ventral to the PLL under direct visualization (Group M) and the non-injection group (Group N). The injection group received a 5 ml injection of 1% lidocaine. Data collected included patient back pain Visual Analogue Scale (VAS) scores, Mean Arterial Pressure (MAP), Heart Rate (HR) at designated time points, Modified Mac Nab criteria, Quebec Back Pain Disability Scale (QBPDS) scores, total intravenous hydromorphone dosage, patient satisfaction surveys, and complications.

Results: At T3, Group M showed significantly lower back pain VAS [3.0 (3.0,3.0)] than Group N [4.0 (3.0,5.0)] (P < 0.001), along with lower MAP and HR (P < 0.05). Anesthesia satisfaction was higher in Group M (95.8% vs. 78.3%, P < 0.05). Hydromorphone use was lower in Group M [0.80 (0.60,1.08) mg] (P < 0.05). No significant differences were found in modified Macnab, QBPDS, or complications.

Conclusions: Local anesthetic injection to the ventral side of PLL under endoscopic visualization effectively alleviated intraoperative pain during PTED, improved patient satisfaction with anesthesia, and was not associated with serious complications.

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Who is the presenting author?: Huacheng Zhou

Who is the senior author?: Huacheng Zhou

Special Interest Group (SIG) Poster/Travel Awards: Musculoskeletal Pain SIG

Is your abstract directly related to the IASP 2026 Global Year theme of Neuropathic Pain?: No