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DOI: 10.4103/ajm.AJM_73_18
Epidural analgesia for percutaneous kyphoplasty in a patient with multiple medical comorbidities
Financial support and sponsorship Nil.
Abstract
Kyphoplasty is a minimally invasive procedure intended to stabilize the fractured bone and restore bone height. It involves percutaneous introduction of an inflatable bone tamp into a fractured vertebral body, followed by injection of bone cement into the ballooned pocket. Anesthetic options typically considered for this procedure include intravenous sedation or general anesthesia. These patients are often elderly, frail, in significant pain, and may poorly tolerate sedation or general anesthesia in the prone position. Spinal anesthesia has been suggested as an alternative method. However, it has major limitations. We would like to report a case of a 79-year-old patient with multiple comorbidities, who presented for kyphoplasty, where epidural anesthesia was conducted and successfully provided adequate analgesia as well as optimal surgical conditions.
Key messages:
Epidural anesthesia can provide successful operating conditions for kyphoplasty.
General anesthesia need not be a default technique in medically complex patients.
There may be many other procedures where regional techniques may provide surgical anesthesia.
Publication History
Article published online:
09 August 2021
© 2019. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Luginbühl M. et al. Percutaneous vertebroplasty, kyphoplasty and lordoplasty: Implications for the anesthesiologist. Curr Opin Anaesthesiol 2008; 21: 504-13
- 2 Mohr M, Pillich D, Kirsch M, Mueller JU, Fleck S, Hosten N. et al. Percutaneous balloon kyphoplasty with the patient under intravenous analgesia and sedation: A feasibility study. AJNR Am J Neuroradiol 2011; 32: 649-53
- 3 Kurra S, Metkar U, Lieberman IH, Lavelle WF. The effect of kyphoplasty on mortality in symptomatic vertebral compression fractures: A review. Int J Spine Surg 2018; 12: 543-8
- 4 Hannallah M, Gibby E, Watson V, Sarin YK. Fluoroscopy-guided, small-dose spinal anesthesia for kyphoplasty: A collaborative effort between the anesthesiologist and interventional radiologist. Anesth Analg 2008; 106: 1329-30
- 5 Souvatzis X, Katonis PG, Licoudis SA, Marouli DG, Askitopoulou H. Case report: Subarachnoid anesthesia for kyphoplasty: Is anesthesia adequate?. Anesth Analg 2010; 111: 238-40
- 6 Georgy BA. Metastatic spinal lesions: State-of-the-art treatment options and future trends. AJNR Am J Neuroradiol 2008; 29: 1605-11
- 7 Berlemann U, Franz T, Orler R, Heini PF. Kyphoplasty for treatment of osteoporotic vertebral fractures: A prospective non-randomized study. Eur Spine J 2004; 13: 496-501
- 8 Kobayashi K, Shimoyama K, Nakamura K, Murata K. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 2005; 15: 360-7
- 9 Guay J, Choi PT, Suresh S, Albert N, Kopp S, Pace NL. Neuraxial anesthesia for the prevention of postoperative mortality and major morbidity: An overview of Cochrane systematic reviews. Anesth Analg 2014; 119: 716-25
- 10 Apan A, Cuvaş ApanÖ, Köse EA. Segmental epidural anesthesia for percutaneous kyphoplasty: Comparison with general anesthesia. Turk J Med Sci 2016; 46: 1801-7
- 11 Selvan RB, Veliath DG, Rao PB, Ramachandran. Ranjan RV. Cholecystectomy under segmental thoracic epidural block in a patient with twin gestation. Saudi J Anaesth 2012; 6: 73-5