Intranasal Dexmedetomidine Combined with Local Infiltration Anesthesia for Perioperative Pain and Anxiety in PELD: A Retrospective Cohort Study.

BACKGROUND: Awake percutaneous endoscopic lumbar discectomy (PELD) preserves intraoperative patient feedback, but local infiltration anesthesia may inadequately control pain and anxiety during deeper procedural stages. Intranasal dexmedetomidine offers a noninvasive adjunct, although evidence in this setting remains limited. METHODS: This two-center retrospective cohort study included 135 adults undergoing PELD with local infiltration anesthesia alone (n=80) or adjunctive intranasal dexmedetomidine (n=55). Pain and anxiety were assessed using the VAS and HADS-A, respectively. VAS scores were analyzed using a linear mixed model adjusted for study center and prespecified covariates. HADS-A scores were analyzed using ANCOVA adjusted for center, baseline HADS-A, and the same patient-level covariates. RESULTS: After adjustment for center and prespecified baseline covariates, recorded pain was lower in the intranasal dexmedetomidine group at puncture, channel establishment, annular incision or nucleus removal, and the end of surgery. The largest adjusted difference occurred during annular incision or nucleus removal (mean difference, -1.81; 95% CI, -2.09 to -1.54; Holm-adjusted P<0.001). Rescue analgesia was recorded in 4 of 55 patients (7.3%) versus 18 of 80 (22.5%). Any adverse event was documented in 5 of 55 patients (9.1%) versus 8 of 80 (10.0%). CONCLUSION: In this retrospective cohort, intranasal dexmedetomidine was associated with lower recorded procedural pain and anxiety, lower hemodynamic peaks, and less frequent rescue analgesia. The observational design precludes causal inference and cannot establish safety regarding uncommon events. Prospective randomized evaluation is warranted.