Comparison of low-concentration ropivacaine epidural anesthesia versus local infiltration anesthesia in percutaneous endoscopic surgery for lumbar disc herniation.

OBJECTIVE: To compare the efficacy and safety of low-concentration ropivacaine epidural anesthesia with that of local infiltration anesthesia in patients undergoing percutaneous endoscopic surgery for lumbar disc herniation (LDH). METHODS: From May 2023 to June 2025, 110 patients who underwent single-level percutaneous endoscopic lumbar discectomy were assigned to either a control group receiving local infiltration anesthesia with low-concentration ropivacaine or an observation group receiving epidural anesthesia with low-concentration ropivacaine. Surgical outcomes, hemodynamic parameters, Ramsay sedation scores, visual analog scale (VAS) pain scores, inflammatory markers, and pain mediators were compared between the two groups. Repeated measures analysis of variance (ANOVA) with Bonferroni post hoc correction was used for analysis of longitudinal data. RESULTS: Compared with the control group, the observation group had a longer postoperative ambulation time but required a lower total dose of ropivacaine and a lower rate of rescue sufentanil analgesia (P < 0.05). Intraoperatively, the observation group showed lower mean arterial pressure (MAP) and heart rate (HR) at T1-T3, whereas Ramsay sedation scores at T1-T4 were significantly higher (P < 0.05). Postoperatively, VAS pain scores at T5-T9 were distinctly lower in the observation group. In addition, levels of inflammatory markers and pain mediators, including 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2), were reduced at 24 h and 72 h postoperatively (P < 0.05). Significant effects of time, group, and time × group interaction were observed for all hemodynamic, sedation, pain, and inflammatory variables (P < 0.05). Adverse event rates did not differ between groups (P > 0.05). CONCLUSION: Low-concentration ropivacaine epidural anesthesia provides better intraoperative hemodynamic stability, deeper sedation, more effective postoperative analgesia, and stronger suppression of inflammatory responses and pain mediator release compared with local infiltration anesthesia in patients undergoing percutaneous endoscopic surgery for LDH.