Study Design. Single-center, single-surgeon retrospective observational study using segmented regression interrupted time series (ITS) analysis. Objective. To evaluate whether epinephrine-added irrigation improves operative efficiency and visualization during uniportal full-endoscopic unilateral laminotomy for bilateral decompression (FESS-ULBD) after adjusting for the learning curve. Summary of Background Data. Maintaining a clear operative field under continuous irrigation is a major challenge in full-endoscopic lumbar decompression. Epinephrine-added irrigation improves visualization in arthroscopy, but evidence in endoscopic spine surgery is limited and may be confounded by learning curve effects. Methods. Fifty consecutive single-level FESS-ULBD cases for degenerative lumbar spinal stenosis were analyzed (saline-only irrigation SAL, n=24; epinephrine-added irrigation EPI, n=26). Segmented regression ITS models were applied to evaluate operative time, endoscopic visibility, and hemostasis while adjusting for case sequence (learning curve), post-implementation slope change, and sex. Results. Mean operative time decreased from 99.3 minutes (SD 18.5) in SAL to 60.7 minutes (SD 9.4) in EPI ( P <0.001). ITS analysis demonstrated a significant immediate reduction in operative time (level change −18.3 minutes, 95% CI −33.7 to −2.9; P =0.024) and reduced variability (residual SD 17.5 to 7.2 minutes; P =0.001). Visibility improved (median “Good” 44.4% vs. 100%; ITS OR 668.8; P =0.004), and the need for hemostasis decreased (ITS OR 0.021; P =0.032). Under routine monitoring, intraoperative hypertension events occurred at similar rates between groups (17% vs. 15%), and no antihypertensive medication was required. Conclusion. After adjusting for learning curve effects using segmented regression ITS analysis, epinephrine-added irrigation during FESS-ULBD improved visualization and reduced hemostasis burden, resulting in shorter and more consistent operative times without clinically apparent hemodynamic instability under routine monitoring or increased postoperative bleeding.
Takenaka et al. (Mon,) studied this question.
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