Continuous i.v. infusion of remifentanil and intraosseous lidocaine provide better analgesia than intraosseous lidocaine alone in percutaneous vertebroplasty of osteoporotic fractures

Evaluation of the analgesic effect of vertebral cancellous bone infiltration anaesthesia during vertebroplasty

Objective

To evaluate the analgesic effect of vertebral cancellous bone infiltration anaesthesia during percutaneous vertebroplasty (PVP).

Methods

Patients treated with vertebral cancellous bone infiltration anaesthesia (intervention group) or local anaesthesia alone (control group) during PVP at our institution during 2016–2018 were reviewed. The visual analogue scale (VAS) score before the operation, during establishment of the puncture channel, during pressure changes in the vertebral body (e.g., when removing or inserting pushers or needle cores), during bone cement injection, immediately after the operation, and at 2 h and 1 day postoperatively were compared between the groups. The patient’s satisfaction with the operation was recorded and compared between groups.

Results

A total of 112 patients were enrolled (59 cases in the intervention group and 53 cases in the control group). There was no difference in the VAS score between the groups before the operation or during establishment of the intraoperative puncture channel (P > 0.05). The VAS score in the intervention group was significantly lower than that in the control group during pressure changes in the vertebral body (removal or insertion of puncture needle cores or pushers) and bone cement injection (P < 0.05). Immediately after the operation and at 2 h postoperatively, the pain in the intervention group was also significantly lower than that in the control group (P < 0.05), but there was no significant difference between the groups at 1 day postoperatively (P > 0.05). The patient satisfaction rate was 88% (52/59) in the intervention group and 67% (35/53) in the control group (P < 0.05).

Conclusions

Vertebral cancellous bone infiltration anaesthesia may effectively relieve intraoperative pain and improve the surgical experience of patients without affecting the clinical effect of surgery.

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

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).

METHODS

Patients > 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.

RESULTS

There 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.

CONCLUSIONS

During 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.

[Bone resin based vertebral augmentation: form of anesthesia and systemic complications]

Over the last few years bone resin based vertebral augmentation in the form of vertebro- and kyphoplasty has proved to be a safe therapeutic option in cases of vertebral compression fractures. Nevertheless, rare systemic complications have been seen, i.e., pulmonary embolisms ranging from harmless to lethal.The presence of an anesthesiologist can be especially useful in cases of systemic complications. Whether the form of anesthesia has any influence on the outcome of vertebro- or kyphoplasty is currently unknown. Local anesthesia supplemented by analgosedation is often used as an alternative to general anesthesia. The rationale for one or the other form of anesthesia can be factors like type of augmentation (vertebro- or kyphoplasty), number of vertebral levels to be treated as well as the patient's age, condition, and comorbidities.Single-shot epidural anesthesia is yet another anesthetic option that has been successfully used in our clinic for some years now. It combines the advantages of general and local anesthesia: excellent segmental analgesia even in multilevel cases in awake and responding patients.