Percutaneous Balloon Kyphoplasty with the Patient under Intravenous Analgesia and Sedation: A Feasibility Study

Mohr, Magni; Pillich, Dirk T; Kirsch, Muriëlle; Mueller, Jane; Fleck, Stephen; Hosten, Norbert; Langner, Sönke

doi:10.3174/ajnr.a2345

Cited by 16 publications

(14 citation statements)

References 29 publications

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“…Over the past decade, development of percutaneous fixation and fusion techniques, notably pedicle screwbased posterior instrumentation systems, have made posterior thoracolumbar spinal fusion procedures possible via relatively tiny incisions (1,2). The percutaneous access of the pedicle, such as for vertebral biopsy or cement augmentation, is a routine procedure typically performed within a fluoroscopy suite using local anesthesia and sedation (3). Since percutaneous pedicle screw placement is essentially conceptually identical to vertebroplasty, it is a natural progression to envision the placement of pedicle screw fixation systems in the angiography suite environment.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous thoracolumbar decompression combined with percutaneous pedicle screw fixation and fusion: a method for treating spinal degenerative pain in a biplane angiography suite with the avoidance of general anesthesia

Chopko¹

2016

J. Spine Surg.

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Section: Introductionmentioning

confidence: 99%

Percutaneous thoracolumbar decompression combined with percutaneous pedicle screw fixation and fusion: a method for treating spinal degenerative pain in a biplane angiography suite with the avoidance of general anesthesia

Chopko¹

2016

J. Spine Surg.

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“…Sedative analgesia with opioids and benzodiazepines, which controls the patient's anxiety and pain without the need for an intervention to maintain respiratory and cardiac function, may be appropriate for elderly patients with increased general anaesthesia risk. However, the use of sedatives in elderly patients in the prone position may carry the potential for opioid-induced respiratory depression [4,14]. Although subarachnoid and thoracic epidural anesthesia may be effective for PKP, these anesthesia methods are often associated with a high failure rate and complications such as epidural hematoma, infection, hypotension and urinary retention [3,15].…”

Section: Discussionmentioning

confidence: 99%

“…General anesthesia adds its own risks for elderly patients and prevents clinical assessment of bone cement leakage during the procedure [3]. Although monitored sedative analgesia is a safe and feasible method for PKP, which can be hazardous, especially with the patient in the prone position, as conventional systemic opioid administration entails the potential risk of respiratory depression [4]. Local anaesthesia for PKP is effective, well tolerated and easy to use.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided thoracic paravertebral block for percutaneous kyphoplasty: A prospective non-randomized comparative study

Tang

Xia

TANG

et al. 2020

Preprint

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Introduction Kyphoplasty for osteoporotic vertebral compression fractures was short but painful. The purpose of the current study was to investigate the effects and safety of ultrasound-guided thoracic paravertebral block in patients undergoing percutaneous kyphoplasty (PKP). Methods A prospective study of 195 patients with thoracic compression fracture undergoing PKP was conducted. The patients were non-randomly assigned to receive an ultrasound-guided thoracic paravertebral block (Group P, n=96) and local infiltration anesthesia (Group L, n=99), and were compared along with intraoperative parameters and anesthetic effects. Visual analog scale (VAS) of pain, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured at pre-anesthesia (T0), post-anesthesia (T1), trocar insertion (T2), balloon dilatation (T3), cement injection (T4) and post-operation (T5). Results The anesthesia time was significantly longer in group P than in group L. There were no significant differences in the epidemiological data, operation time, blood loss, hospitalization time complications and costs between the two groups. The additional analgesics rate was significantly lower in group P than in group L. The investigators’ satisfaction scores, patients’ anesthesia satisfaction scores and intention rate of re-administration anesthesia were significantly higher in group P than in group L. Intraoperative VAS score (T1-T4) was significantly lower in group P than in group L. There was no significant difference in VAS scores (T0 and T5), SBP, DBP and HR between these two groups. Conclusion Ultrasound - guided thoracic paravertebral block achieved more effective analgesia in comparison to local infiltration groups in patients undergoing percutaneous kyphoplasty.

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“…Mohr et al. 15 reported that i.v. piritramide and midazolam during kyphoplasty were well tolerated and useful for their sedative and analgesic properties; Della Puppa et al.…”

Section: Discussionmentioning

confidence: 99%

Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty

Lee

et al. 2016

J Int Med Res

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Objectives This clinical trial is registered at ClinicalTrials.gov. (NCT02476981)This randomized, prospective double-blind study compared remifentanil with dexmedetomidine for monitored anaesthesia care during minimally invasive corrections of vertebral compression fractures (vertebroplasty or kyphoplasty).MethodsPatients > 65 years of age with American Society of Anesthesiologists (ASA) classification I–III, scheduled for vertebroplasty or kyphoplasty under monitored anaesthesia care, received remifentanil (i.v. infusion 1–5 µg/kg/h) or dexmedetomidine (loading dose 0.3–0.4 µg/kg followed by i.v. infusion 0.2–1 µg/kg/h) to maintain observer's assessment of alertness/sedation (OAA/S) scale <4 during the procedure.ResultsThere were no statistically significant differences in demographic data between the remifentanil (n = 37) and dexmedetomidine groups (n = 38). Patients on dexmedetomidine experienced lower mean arterial pressure (MAP) and heart rate (HR), and higher SpO2 values, than patients on remifentanil. Compared with dexmedetomidine, remifentanil produced more respiratory depression, oxygen desaturation, and reduced the need for additional intraoperative opioids. There were no significant between-group differences in terms of recovery time, investigators’ satisfaction scores, or patients’ overall pain experiences.ConclusionsDuring monitored anaesthesia care, dexmedetomidine provides less respiratory depression, lower MAP and HR, but also less analgesic effect than remifentanil in elderly patients undergoing vertebroplasty or kyphoplasty.

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Percutaneous Balloon Kyphoplasty with the Patient under Intravenous Analgesia and Sedation: A Feasibility Study

Cited by 16 publications

References 29 publications

Percutaneous thoracolumbar decompression combined with percutaneous pedicle screw fixation and fusion: a method for treating spinal degenerative pain in a biplane angiography suite with the avoidance of general anesthesia

Percutaneous thoracolumbar decompression combined with percutaneous pedicle screw fixation and fusion: a method for treating spinal degenerative pain in a biplane angiography suite with the avoidance of general anesthesia

Ultrasound-guided thoracic paravertebral block for percutaneous kyphoplasty: A prospective non-randomized comparative study

Comparison of remifentanil with dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty

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