Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures

Abstract

Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.

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

“…Several studies have aimed to optimize the anesthesia technique used for PKP. Ge et al 10 found that anesthesia monitoring and dexmedetomidine use can result in better patient cooperation, a shorter duration of surgery, and a lower incidence of adverse events due to better sedation and analgesia than GA and LA. However, postoperative circulatory dysfunction can occur, and mean arterial pressure and heart rate should be closely observed and monitored postoperatively.…”

“…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. [14][15][16] We believe that LA with additional intravertebral anesthesia (IVA) can improve tolerance to surgery and avoid GArelated complications.…”

“…[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.…”

Anesthesia care in the interventional neuroradiology suite: an update

“…Overall, MAC had the highest periprocedural satisfaction and lowest VAS 2 h after the procedure, with improved patient cooperation and a decreased risk of adverse events during PKP. The MAP and HR in the MAC group should be closely observed postprocedurally [47 ▪ ].…”

Anaesthetic considerations for high-risk patient kyphoplasty

“…The most common anaesthetic techniques used are general anaesthesia and local infi ltration anaesthesia, which can be combined with sedation/anxiolysis and monitored anaesthesia care (2,3).…”