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Abstract
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Background and Aims Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Several anesthetic techniques (local, regional (paravertebral block (PRV)/Erector Spinae block (ESP) or general anesthesia(GA)) have been proposed to control pain during kyphoplasty, although in our center GA is preferred.
Methods A 76-year-old male, with T11 OVCF and intractable pain was proposed for kyphoplasty. Medical history: ASA IV, dilated cardiomyopathy (left ventricular ejection fraction 15%), myasthenia gravis, COPD Gold 4, obstructive sleep apnea, obesity (BMI 35), hypertension and diabetes mellitus. Patient was initially turned down for kyphoplasty due to the high anesthetic risk of GA, but the pain was unbearable. We decided underwent surgery under bilateral ESP at T11 level in prone position using ropivacaine 0,5% + dexamethasone 4mg (20ml/side) without sedation.
Results The procedure was well tolerated by the patient, without any sedation. No postoperative complications occurred. Numerical rating pain scale (NRPS) were before/during/24 hours and month postoperatively: 10/0/2/1. Patient was discharged the day after surgery. Kyphoplasty was successful improving pain, mobility and quality of life.
Kyphoplasty procedure
Needle transpedicular approach for kyphoplasty
Ultrasound anatomy thoracic ESP block
Conclusions Many of patients with OVCF indicated for kyphoplasty are elderly with severe comorbidities, which puts them at high risk for GA. Surgery performed under RA associated or not to mild sedation offers an interesting alternative to GA. ESP at the level of the vertebral fracture achieves optimal analgesic conditions as PRV for kyphoplasty. The advantages of ESP are its ease of performance and a better safety profile. Therefore, in this patient, considering medical history, ESP could be the best anesthetic strategy.