Background and Aims Kyphoplasty for vertebral compression fractures is a short but painful procedure especially during trocar insertion, baloon dilatatuon and cement injection. Various anesthetic techniques to control pain in elderly population are tried, but all have limitations. The following case study is to demonstrate the safety and effectiveness of a paravertebral block combined with light sedation as anesthetic method in an elderly patient with COPD.
Methods A 90 years old patient presented with a T10 vertebra fracture and was scheduled for kyphoplasty. He also had severe COPD with an FEV1<30% of normal. Intraoperative monitoring consisted of ECG, NIBP and SPO2. Supplementary oxygen with a facemask 28% at 2lt/min was supplied. Induction sedation of 1 mg midazolam, 20 mg pethidine and 0,7 mg/kg dexmedetomidine dosed within 10 min were given to the patient.
To promote airway safety a nasal airway No 7 was also placed.
After placing patient in a prone position we performed a paravertebral block with 10 ml of 10% ropivacaine at the fracture level under ultrasound guidance. Sedation with 0,7 mg/kg/hr dexmetomidine and 0,05 mg/kg/min remifentanyl were administered during the procedure.
Results The sedation score recorded at -3, evaluated using the RASS scale. This fell under moderate sedation.
Using the VAS scale, intraoperative and postoperative pain score, recorded at 2–3 level, were minimal. Pulse rate, SpO2, and NIMB were stable intraoperatively..
Conclusions The case study showed that ultrasound guided paravertebral block combined with sedative analgesia is a safe and feasible method for minimally invasive treatment of vertebrae fractures in elderly patients with COPD.
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