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.
Highlights
Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); both are associated with adverse reactions
Analysis of variance showed that these differences in the mean arterial pressure (MAP) and heart rate were statistically significant at the time of trocar puncture into the vertebral body, injection of bone cement into the vertebral body and 2 h postoperatively
The monitored anesthesia group had a significantly lower MAP and heart rate than the general anesthesia group 2 h postoperatively (P < 0.01); hypotension and bradycardia were not observed in the monitored anesthesia group
Summary
Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); both are associated with adverse reactions. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery. Monitored anesthesia with dexmedetomidine has rarely been used during PKP, and no study comparing monitored anesthesia with local and general anesthesia has been reported. In view of the known disadvantages with local and general anesthesia, we determined if monitored anesthesia is an effective alternative anesthetic approach during PKP. A prospective, non-randomized controlled trial was conducted to compare the effects of the three different anesthesia modalities during PKP
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