Comparison of Local, Epidural, and Combined Spinal-Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Focus on Perioperative Efficiency and Early Recovery

Objective To comprehensively compare the effects of local anesthesia (LA), epidural anesthesia (EA), and combined spinal-epidural anesthesia (CSEA) on perioperative efficiency and early recovery in patients undergoing single-level percutaneous transforaminal endoscopic discectomy (PTED). Methods In this retrospective cohort study, clinical data of patients who underwent PTED between February 2023 to August 2024 were reviewed and categorized into three groups based on anesthetic technique: LA group, EA group, and CSEA group. Primary outcomes included operative time and intraoperative blood loss. Secondary outcomes encompassed hospitalization costs, pain intensity assessed by the Visual Analogue Scale (VAS), functional status evaluated by the Oswestry Disability Index (ODI) at preoperative, 3-day, and 3-month intervals, surgical experience measured by a Likert scale, and the success rate according to the modified MacNab criteria at 6 months. Results A total of 120 patients were included (n = 40 per group). The three groups were comparable in baseline demographics. The CSEA group demonstrated superior perioperative efficiency, exhibiting the shortest operative time and the least intraoperative blood loss among the three groups ( P  < 0.05), followed by the EA group. Patients in the CSEA group reported the most favorable intraoperative experience ( P  < 0.001). While pain and function improved significantly in all groups after surgery, the CSEA group achieved significantly lower VAS and ODI scores at the 3-month follow-up compared to both the EA and LA groups (P  < 0.05), with the EA group showing better scores than the LA group. All three techniques resulted in similarly high success rates at 6 months with no statistically significant difference. Conclusion For PTED, the choice of anesthesia significantly impacts perioperative course and early recovery. CSEA is associated with the greatest advantages in operative efficiency, patient comfort, and the speed of pain relief and functional recovery within the first 3 months, likely attributable to its unique mechanism of rapid and dense sensory blockade. EA offers an intermediate benefit profile compared to LA. These findings provide evidence for refining anesthesia protocols within an enhanced recovery after surgery (ERAS) framework for spinal endoscopic procedures.