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Zhong X, Xia H, Li Y, Tang C, Tang X, He S. Effectiveness and safety of ultrasound-guided thoracic paravertebral block versus local anesthesia for percutaneous kyphoplasty in patients with osteoporotic compression fracture. J Back Musculoskelet Rehabil 2022; 35:1227-1235. [PMID: 35599464 DOI: 10.3233/bmr-210131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Different anesthetic techniques have been proposed to control pain during kyphoplasty; however, all have limitations. OBJECTIVE To compare the effectiveness and safety of ultrasound-guided thoracic paravertebral block with local anesthesia for percutaneous kyphoplasty (PKP). METHODS In this prospective study, non-randomized patients with OVCF undergoing PKP received either ultrasound-guided thoracic paravertebral block (group P) or local anesthesia (group L). Perioperative pain, satisfaction with anesthesia, and complications were compared between the groups. RESULTS Mean intraoperative (T1-T4) perioperative visual analog scale (VAS) scores were significantly lower in group P than in group L (2 [1-3] vs. 3 [2-4], 2 [2-3] vs. 4 [2-4], 2 [2-3] vs. 5 [3-5], and 3 [2-3] vs. 5 [3-5], respectively; P< 0.05). Investigators' satisfaction scores, patients' anesthesia satisfaction scores, and anesthesia re-administration intention rate were significantly higher in group P than in group L (4 [3-5] vs. 3 [2-4], 2 [2-3] vs. 2 [1-3], 90.63% vs. 69.70%; P< 0.05). There was no significant intergroup difference in complications. CONCLUSIONS Ultrasound-guided thoracic paravertebral block has similar safety to and better effectiveness than local anesthesia in PKP.
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Affiliation(s)
- Xiqiang Zhong
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haijie Xia
- Department of Anesthesiology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojun Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Xiang J, Zhong W, Ou Y. Comparison of the Effect of Different Local Analgesia Administration Methods in Percutaneous Vertebroplasty: A Retrospective Cohort Study. Front Surg 2022; 9:769102. [PMID: 35402496 PMCID: PMC8990094 DOI: 10.3389/fsurg.2022.769102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Although various studies have described the methods of administering anesthesia during percutaneous vertebroplasty (PV) for treating osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. Therefore, this study aimed to investigate the effects of three application methods of local analgesia administration in PV for treating OVCFs. Methods A total of 96 patients with OVCFs were reviewed and divided into three groups (A: lidocaine, B: ropivacaine, C: lidocaine + ropivacaine). The visual analog scale (VAS), blood pressure (BP), heart rate (HR), blood oxygen saturation (BOS), and surgery time were recorded during the following different points: before puncture, during the puncture, cement injection, and 4-h after surgery. Results The mean age of the patients was 74.13 ± 7.02 years in group A, 70.47 ± 5.50 years in group B, and 73.07 ± 7.51 years in group C, without significant difference. No significant differences were found in sex, age, hospital stay, surgery time, blood loss, and cement volume of the patients. In the periods of before puncture and 4-h after surgery, the VAS in group C decreased significantly than that in the periods of the puncture, cement injection, and immediately after surgery. Overall, there were no significant differences in systolic BP, diastolic BP, HR, and BOS during the different periods among the groups except HR in the period of the puncture in group C, which was slower than that in other groups, and HR in the period of cement injection in group A, which was faster than the other two groups. A correlation was observed between the VAS and the periods of cement injection (r = 0.5358) and after surgery (r = 0.5775) in group C. Conclusion Compared with the other two methods, the use of lidocaine in combination with ropivacaine could effectively relieve intraoperative pain, making the patients feel more comfortable and experience better recovery.
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Affiliation(s)
- Jiangxia Xiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Weiyang Zhong
| | - Yunsheng Ou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Yunsheng Ou
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A Study on the Anatomical Relationship of the Lumbar Extrapedicular Puncture Approach with the Spinal Nerve and its Branches. Spine (Phila Pa 1976) 2021; 46:E611-E617. [PMID: 33428360 DOI: 10.1097/brs.0000000000003947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The anatomical relationship of the extrapedicular approach with the spinal nerve and its branches was researched in cadavers. Three types of extrapedicular paths were simulated: puncture inside the medial branch (MB), puncture outside the MB, and puncture outside the lateral branch (LB). At L1-L3, puncture outside the LB could avoid damage to these nerves.
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Zhang S, Xu S, Yang J, Wang S, Wang Q. Analysis of percutaneous kyphoplasty under different types of anesthesia for the treatment of multiple osteoporotic vertebral fractures. BMC Musculoskelet Disord 2020; 21:743. [PMID: 33183281 PMCID: PMC7664068 DOI: 10.1186/s12891-020-03778-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Surgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs. Methods A retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups. Results The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups. Conclusion PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.
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Affiliation(s)
- Shuai Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Shuang Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Song Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China.
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China.
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Analysis of Anesthesia Methods in Percutaneous Kyphoplasty for Treatment of Vertebral Compression Fractures. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:3965961. [PMID: 31998468 PMCID: PMC6973186 DOI: 10.1155/2020/3965961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
Aim Percutaneous kyphoplasty (PKP) is a routine operation for the treatment of vertebral compression fracture (VCF). Both local anesthesia and general anesthesia are widely used for PKP. However, which type of anesthesia is better for PKP still remains uncertain. This study aimed to find out whether local anesthesia or general anesthesia is more suitable for PKP. Methods This is a retrospective clinical trial. A total of 85 single-level VCF patients who received PKP 12 months ago were recruited in this study. 45 patients who received local anesthesia were in group L, and 40 patients with general anesthesia were in group G. Clinical, radiological, and economic data between the two groups were collected. Results No difference was found on preoperative data between the two groups. The duration of operation time in group L was longer than that in group G. Within 12 months after PKP, more complications happened in group G than those in group L. Results No difference was found on preoperative data between the two groups. The duration of operation time in group L was longer than that in group G. Within 12 months after PKP, more complications happened in group G than those in group L. Conclusion Both local anesthesia and general anesthesia were reliable for PKP. However, local anesthesia was more efficient and safer with less expense and more bearable pain when compared with general anesthesia.
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Liu L, Wang H, Wang J, Wang Q, Pu Y, Wang Z, Wu Y, Xu Y, Jin W. A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty. Medicine (Baltimore) 2019; 98:e16792. [PMID: 31415385 PMCID: PMC6831313 DOI: 10.1097/md.0000000000016792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extrapedicular infiltration anesthesia (EPIA) was reported for percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) and provided good local anesthetic effects. Because of differences in anatomical morphology at each lumbar level, the puncture method of EPIA is not uniform in each lumbar vertebrae. To accurately insert the anesthetic needle into the extrapedicular region, we researched the puncture method of EPIA at each lumbar level.We retrospectively analyzed computed tomography (CT) images in 230 patients with lumbar osteoporotic fractures, including 59 L1 fractures, 54 L2 fractures, 50 L3 fractures, 36 L4 fractures, and 31 L5 fractures. The puncture of EPIA was simulated in every fractured vertebrae through CT, and the skin puncture point, puncture direction, and puncture depth of the anesthetic needle were observed. These specific parameters were the distance from the skin puncture point to the superior border of the pedicle projection on the skin (distance AD), distance from the skin puncture point to the lateral border of the pedicle projection on the skin (distance BC), sagittal section angle (SSA), transverse section angle (TSA), and depth of EPIA.As the lumbar ordinal number increased, the SSA, distance AD, TSA, and distance BC for each lumbar level gradually increased, and the puncture depth gradually decreased, all these parameters showed significant differences among the 5 lumbar levels (P < .001). The recommended puncture methods for EPIA at each lumbar level, including distance AD, distance BC, SSA, and TSA, were as follows: in L1, 4 mm, 8 mm, 9° and 8°; in L2, 6 mm, 10 mm, 11° and 10°; in L3, 9 mm, 13 mm, 12° and 12°; in L4, 12 mm, 18 mm, 16° and 18°; and in L5, 20 mm, 26 mm, 24° and 24°. The depth of EPIA was 13 mm in L1-L3 and 11 mm in L4-L5.By confirming the skin puncture point and puncture direction of the anesthetic needle, from an anatomical perspective, EPIA is feasible for lumbar PVP (PKP).
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Affiliation(s)
- Liehua Liu
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Haoming Wang
- Department of Orthopedics, Three Gorges Central Hospital
| | - Jiangang Wang
- Department of Orthopedics, No. 13 People's Hospital of Chongqing, Chongqing, China
| | - Qian Wang
- Hillsborough Community College, Tampa, FL
| | - Yu Pu
- Chengdu Public Health Centre, Chengdu, Sichuan
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Yuexiang Wu
- Outpatient Department, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Yuan Xu
- Department of Orthopedics, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
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The Effect of Intraoperative Vertebral Anesthesia on Osteoporotic Fractures Treated With Percutaneous Kyphoplasty: A Prospective Cohort Study. Clin Spine Surg 2019; 32:E289-E296. [PMID: 31021875 DOI: 10.1097/bsd.0000000000000823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A prospective randomized cohort study. OBJECTIVE The objective of this study was to investigate the effect of intraoperative vertebral anesthesia on osteoporotic vertebral compression fractures (OVCFs) when treated with percutaneous kyphoplasty (PKP). SUMMARY OF BACKGROUND DATA Only a few studies have evaluated the intraoperative pain reducing strategies during PKP. MATERIALS AND METHODS A total of 64 patients with OVCFs were enrolled in the study. All of the patients were randomized into 2 groups: the traditional local anesthesia group (from the skin to the periosteum, group A) and the experimental group (from the skin to a vertebral body, group B). Visual Analogue Scale (VAS) score was used to evaluate the degree of pain at six time points, that is, VAS before surgery, VAS during balloon dilation, VAS during bone cement injection, VAS soon after surgery, and VAS 12 hours and 24 hours after surgery. In addition, we noted the patients' willingness to undergo reoperation if necessary, and the variations in surgical complications between the 2 groups. RESULTS There was no significant difference in VAS score before surgery between the 2 groups (t=1.694, P=0.095). The VAS scores during balloon dilatation, bone cement injection and soon after surgery were significantly different between the 2 groups (t=4.405, P=0.000; t=2.481, P=0.016; t=2.992, P=0.004, respectively). The willingness to undergo reoperation was significantly different between 2 groups (χ=6.020, P=0.049), whereas the complications showed no significant difference (χ=0.000, P=0.754). CONCLUSIONS Traditional local anesthesia combined with vertebral anesthesia was effective in alleviating perioperative pain during PKP. No serious complication was noted during the operation. LEVEL OF EVIDENCE Level I.
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Liu L, Cheng S, Wang Q, Liang Q, Liang Y, Jin W, Zhou Q, Wang Z. An anatomical study on lumbar arteries related to the extrapedicular approach applied during lumbar PVP (PKP). PLoS One 2019; 14:e0213164. [PMID: 30835754 PMCID: PMC6400376 DOI: 10.1371/journal.pone.0213164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/12/2019] [Indexed: 11/25/2022] Open
Abstract
To observe the regional anatomy of the lumbar artery (LA) associated with the extrapedicular approach applied during percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), we collected 78 samples of abdominal computed tomography angiography imaging data. We measured the nearest distance from the center of the vertebral body puncture point to the LA (distance VBPP-LA, DVBPP-LA). According to the DVBPP-LA, four zones, Zone I, Zone II, Zone III and Zone IV, were identified. LAs that passed through these zones were called Type I, Type II, Type III and Type IV LAs, respectively. A portion of the lumbar vertebrae had an intersegmental branch that originated from the upper segmental LA and extended longitudinally across the lateral wall of the pedicle; it was called Type V LA. Compared with the DVBPP-LA in L1, L2, L3 and L4, the overall difference and between-group differences were significant (P < 0.05). In L1, L2, L3, L4 and L5, there were 8, 4, 4, 0 and 1 Type I LAs, respectively. There were no Type V LAs in L1 and L2, but there were 2, 16 and 26 Type V LAs in L3, L4 and L5, respectively. In L1-L5, the numbers of Type I LA plus Type V LA were 8, 4, 6, 16 and 27, and the presence ratios were 5.1%, 2.6%, 5.6%, 10.3% and 17.3%, respectively. In L4 and L5, the male presence ratios of Type I LA plus Type V LA were 7.1% and 10.7%, respectively, and the female presence ratios were 13.9% and 25.0%, respectively. Thus, extrapedicular PVP (PKP) in lumbar vertebrae had a risk of LA injury and was not suggested for use in L4 and L5, especially in female patients.
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Affiliation(s)
- Liehua Liu
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Shiming Cheng
- Department of Orthopedics, Chongqing Dongnan Hospital, Chongqing, China
| | - Qian Wang
- Hillsborough Community College, Tampa, Florida, United States of America
| | - Qiang Liang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Yong Liang
- Department of Radiology, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- * E-mail: (ZW); (QZ); (WJ)
| | - Qiang Zhou
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
- * E-mail: (ZW); (QZ); (WJ)
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- * E-mail: (ZW); (QZ); (WJ)
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Iatrogenic Lumbar Artery Injury in Spine Surgery: A Literature Review. World Neurosurg 2019; 122:266-271. [DOI: 10.1016/j.wneu.2018.10.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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Abstract
PURPOSE OF REVIEW With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. RECENT FINDINGS Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. SUMMARY Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.
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