Percutaneous vertebroplasty under epidural anesthesia: comparative study versus local anesthesia

Abstract

Objectives This study aimed to evaluate percutaneous vertebroplasty (PVP) under epidural (EPI) anesthesia and its effect on patients' and surgeons' satisfaction. Patients and methods Sixty-three patients undergoing thoracolumbar PVP were divided randomly as follows: the LA group received local anesthesia (LA) and the EPI group received EPI anesthesia as one pre-emptive shot of 8-10 ml plain levobupivacaine 0.25% (2.5 mg/ml). PVP involved an injection of 4-8 ml polymethlymethacrylate into each treated vertebra. Anesthetic outcome was defined as assessment of injection pain using a 10-point numeric rating scale, hemodynamic stability; efficacy of postoperative (PO) analgesia and patients' satisfaction were rated using the Iowa Satisfaction with Anesthesia Scale for monitored anesthesia care and surgeons' satisfaction was evaluated using a seven-point Likert scale. Surgical outcome was defined as patients' disease-related pain levels assessed before and 24-h PO using numeric rating scale. Results EPI anesthesia provided multiple advantages over LA; injection pain and anxiety-induced tachycardia and hypertension were significantly lower. EPI anesthesia allowed multiple-level PVP in the same setting with a single anesthetic injection; this was reflected as significantly higher surgeon and patient satisfaction. PO pain was significantly lower with EPI versus LA, with less need for PO analgesia. Both groups showed PO improvement in their disease-related pain. Conclusion EPI anesthesia is a safe and effective alternative for LA during PVP. It allowed multiple-level corrections in the same setting, adequate hemodynamic stability and PO analgesia, and resulted in significantly higher surgeon and patient satisfaction, especially those who had one-setting multiple-level corrections.