Rami communicans block prior to transforaminal endoscopic discectomy relieves procedure pain significantly and adds safety: A case–control study
Gautam Das1, Samarjit Dey2, Ravi S Sharma3, Kanchan Sharma4, Debjyoti Dutta5, Chinmoy Roy6
1 Director, Daradia: The Pain Clinic, Kolkata, West Bengal, India
2 Assistant Professor, Department of Anesthesia, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong Meghalaya, India
3 Fellow, Daradia: The Pain Clinic, Kolkata, West Bengal, India
4 Consultant and Incharge, Aadhya Pain Management Center, Jaipur, India
5 Consultant, Pain and Pallliative Care, Narayana Superspeciality Hospital Howrah, Kolkata, India
6 Senior specialist, Pain Management Division, Royal Hospital, Muscat, Oman
Ravi S Sharma
Fellow, Daradia: The Pain Clinic, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background: The ability to isolate and visualize the"pain" generators in the foramen and treat persistent pain by visualizing inflammation and compression of nerves serves as the basis for transforaminal endoscopic (TFE) surgery.It provides a least invasive basic access to the disc. One of the important steps is the insertion of dilator and working sleeve followed by introduction of endoscope. Often this step is carried out with the help of a hammer, which is agonizing for the patients undergoing surgery. This study aims at analyzing the efficacy of the rami communicans nerve block in reducing the intraoperative pain in patients undergoing TFE discectomy.
Materials and methods: A total of 48 patients undergoing TFE discectomy were assigned into two groups. Group I (case, n = 27) received rami communicans block prior to endoscopic discectomy a nd f or g roup II (control, n= 2 1), n o r ami c ommunicans block was given. Under all aseptic precautions, the rami communicans block was given to group I patients after identification of corresponding level. After proper placement of block, lumbar TFE discectomy was performed using the "insideout" approach. Pain was assessed using numerical rating scale (NRS) at different time intervals. Statistical analysis was carried out using independent Student's t-test, chi-squared test, and Mann–Whitney U test.
Results: While comparing NRS, group I showed significantly lower NRS when compared with group II and it was highly significant (p-value < 0.0001). The need for rescue analgesia was also compared and this difference was also found to be highly significant (p-value <0.0001).
Conclusion: The rami communicans block is highly effective in reducing the intraoperative pain in patients undergoing TFE discectomy and thus, reduces the total dose of anesthetics and analgesics intraoperatively.