Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

Abstract

Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females) with osteoporotic vertebral compression fractures with a mean age of 71.4 ± 8.8 years (range: 60 to 89) received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA) and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA). Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5 ± 0.7 and 4.3 ± 1.0, respectively, and there was significant difference (P = 0.001). In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

Analysis of Percutaneous Kyphoplasty under Different Types of Anesthesia for the Treatment of Multiple Osteoporotic Vertebral Fractures

“…To minimize the effect on the general situation of elderly patients, PKP under local anesthesia is an effective method for treating OVFs [10][11][12]. Liu et al reported that local anesthesia for single vertebra PKP surgery can effectively relieve pain.…”

“…Surgeons can directly assess whether a spinal cord nerve injury occurs while the patient is awake. Moreover, patients who receive local anesthesia do not need postoperative resuscitation and can get out of bed early, which is conducive to postoperative rehabilitation [10][11][12]. However, when patients with m-OVFs receive local anesthesia, uoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of body posture-related discomfort, excessive local anesthetic drugs, the toxic reaction of bone cement, and abrupt uctuation of vital signs.…”

Analysis of Anesthesia Methods in Percutaneous Kyphoplasty for Treatment of Vertebral Compression Fractures

“…Percutaneous kyphoplasty (PKP) is a good treatment for patients of VCF who cannot bear the pain or do not get well from conservative treatment [6]. Nowadays, both local anesthesia and general anesthesia are widely used in the PKP process [7][8][9][10][11][12]. However, the controversy about the best type of anesthesia for PKP has never been stopped.…”

An anatomical study on lumbar arteries related to the extrapedicular approach applied during lumbar PVP (PKP)

“…In the puncture technique of the extrapedicular approach, the puncture needle must cling to the lateral side of the upper articular process and the upper edge of the basal transverse process and penetrate the vertebral body at the junction between the lateral side of the pedicle and the posterolateral side of the vertebral body. [5] However, the lumbar artery (LA) is distributed on the posterolateral side of the vertebral body, and the intersegmental branch passes through the lateral side of the pedicle that comes from the upper segmental LA; therefore, the extrapedicular approach carries a risk of LA injury. [6–9] Heo et al .…”