Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty

Abstract

Objective. Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method. A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results. There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion. The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients’ pain in intraoperation and postoperation.

Efficacy of erector spina plane blocks and paravertebral blocks in kyphoplasty surgery

“…Still, it is associated with severe complications such as epidural leakage, spinal hematoma, infection, hypotension, and urinary retention. 11,12 The undesirable side effects of central block methods have made fascial area blocks considered. The distribution of local anesthetics in PVB includes both ventral and dorsal spinal branches, according to a review of anatomical research.…”

Can additional intravertebral anesthesia improve the intraoperative tolerance to percutaneous kyphoplasty for acute osteoporotic thoracolumbar fractures?

“…However, postoperative circulatory dysfunction can occur, and mean arterial pressure and heart rate should be closely observed and monitored postoperatively. Bao et al 9 found that anesthesia with additional intraosseous injection of 1% lidocaine hydrochloride (5 ml) can more effectively relieve intraoperative and postoperative pain than conventional LA. Mao et al 22 reported that traditional LA (15 mL of 0.7% lidocaine to the soft tissue around the spine) combined with vertebral anesthesia (5 mL of 0.7% lidocaine to the vertebral body) was effective for alleviating perioperative pain in patients undergoing PKP.…”

“…However, compared with PKP under LA, PKP under GA has been associated with a higher incidence of complications related to endotracheal intubation and respiratory depression, and postoperative recovery is slower. 9 Additionally, the high cost of PKP under GA should be considered when choosing the type of anesthesia. 10 Numerous studies have con rmed that the sinus nerve plays a major role in the innervation of the vertebral body, and local anesthetics act on the sinus nerve to produce analgesia.…”

“…[1][2][3][4] Local anesthesia (LA) and general anesthesia (GA) are widely used for PKP. [5][6][7][8][9][10] However, there is ongoing controversy regarding the best anesthesia modality for PKP, and research on this topic is sporadic. Surgeons prefer to perform PKP under LA for the following reasons: it is less expensive than GA; allows real-time monitoring of nerve function; enables timely detection of spinal cord compression due to puncture or bone cement leakage; helps to avoid multiple organ dysfunction, which is seen in older adults after GA without postoperative resuscitation; and accelerates postoperative rehabilitation.…”

Anaesthetic considerations for high-risk patient kyphoplasty

“…However, remifentanil and dexmedetomidine seem to be viable options for minimally invasive corrections of compressive vertebral fractures in the elderly (8). An intraosseous injection of local anaesthetic into the vertebral body combined with infi ltration of skin and a separate injection of local anaesthetic to the periosteum have been associated with decreased levels of perioperative and postoperative pain (9). One study highlighted the fact that orally administered sedation combined with local anaesthetic infi ltration should only be reserved for low-risk patients in offi ce-based settings (10).…”