Can additional intravertebral anesthesia improve the intraoperative tolerance to percutaneous kyphoplasty for acute osteoporotic thoracolumbar fractures?

Purpose: To evaluate the efficacy and safety of different types of anesthesia (LA, LA with IVA, and GA) used during PKP.Patients and methods: A total of 150 patients of single-level OTLF were prospectively included in this study from February 2019 to February 2020. They were randomly divided into three groups of 50 patients each and treated with GA, LA, or LA with IVA. Severity of back pain was measured preoperatively, intraoperatively, and 1 h, 1 day, 1 month, and 1 year postoperatively using VAS scores. The ODI was administered and the AHVB on lateral thoracolumbar radiographs was measured preoperatively and at 1 month and 1 year postoperatively. The MMSE was administered at 1 and 7 days postoperatively to monitor for the development of POCD.Results: 131 patients completed the full postoperative follow-up schedule. The average duration of surgery in the LA group was slightly longer than the other two groups. The intraoperative VAS score of the LA+IVA group was significantly lower than that of the LA group. The MMSE scores at 1 day and 1 week postoperatively were significantly decreased only in the GA group. The incidence of POCD was 45% (18/40) at 1 day and 5% (2/40) and at 1 week postoperatively in the GA group, whereas POCD was not observed in the other two groups. The GA group had the highest incidence of anesthesia-related adverse reactions.Conclusion: IVA with ropivacaine can effectively reduce intraoperative and early postoperative pain, shorten the duration of surgery, reduce surgery-related complications.