Anesthetic complications of extensive spinal nerve block and total spinal anesthesia during percutaneous endoscopic spinal surgery under local anesthesia.

purposeTo investigate the causes, manifestations, risk factors and management of anesthetic complications of extensive spinal nerve block (ESNB) and total spinal anesthesia (TSA) during percutaneous spinal endoscopic surgery under local anesthesia.

methodsWe retrospectively reviewed 16,798 patients who underwent percutaneous spinal endoscopic surgery under local anesthesia across three institutions between February 2012 to February 2023. Patient demographics, including gender, age and Body Mass Index (BMI) were collected, along with surgical characteristics such as surgical sites, involved segments, surgical approaches and procedures. Local anesthetic dosage, as well as the onset time, manifestations, management, recovery and prognosis of intraoperative ESNB and TSA were recorded. Statistical analysis including regression analysis was used to identify potential risk factors.

results9 patients (0.05%) experienced anesthetic complications of ESNB and TSA, including 4 males and 5 females, with a mean age of 48.44 ± 18.15 years (range: 28-84 years). The median onset time was 7 min (IQR:5-30 min). The mean follow-up duration was 4.84 ± 2.77 years (range: 1-9 years). 6 cases of ESNB presented with sensory and motor disfunction below the block level, accompanied by mild circulatory and respiratory depression. Among them, 5 patients recovered fully, while 1 patient had residual foot drop. 3 cases of TSA manifested as loss of consciousness, complete sensory and motor loss, and significant circulatory and respiratory depression. Among them, 2 patients underwent tracheal intubation, while 1 patient developed multiple complications but recovered following a 31-day ICU treatment. The thoracic and cervical spine, thoracic transforaminal endoscopic surgery were associated with higher incidences of anesthetic complications (P < 0.05). The interlaminar approach demonstrated a higher incidence of anesthetic complications than the transforaminal approach(P = 0.026). No significant differences were observed in anesthetic dosage and addition of ropivacaine between the complication group and the non-complication group (P > 0.05). BMI was identified as an independent risk factor, significantly higher in the complication group (27.00 ± 5.61 kg/m²) than in the non-complication group (P = 0.038).

conclusionESNB and TSA are rare but serious anesthetic complications in percutaneous spinal endoscopic surgery under local anesthesia. In addition to limb sensory and motor dysfunction, the respiratory and circulatory systems can also be affected. Heightened vigilance and proactive prevention are warranted especially for patients with high BMI, cervical or thoracic intervention, or an interlaminar approach. Prompt identification and scientific treatment are crucial for favorable outcomes.