| Background: As the population aging,the social industrialization and development of tumor diagnosis rats,the osteoporotic vertebral compression fracture,the incidence of traumatic spinal fractures and pathological spine fracture are on the rise year by year,of which the most are elderly osteoporotic compression fractures.Percutaneous kyphoplasty(PKP)is a minimally invasive technique in the development of spine surgery in recent years.General anesthesia and local anesthesia are the main way of anesthesia in PKP and epidural anesthesia was also applied to PKP in some literature,but three anesthetic methods have their respective advantages and disadvantages.Local infiltration has the advantages of anesthesia shorter hospitalization time,less postoperative complications from anesthesia,but some patients with intraoperative pain,someone shouting and crying.Especially with some underlying disease elderly patients the pain makes vital signs volatile increasing the risk of surgery,and postoperative vertebral height restoration unsatisfactory.General anesthesia without intraoperative pain and postoperative vertebral height restoration more satisfied,but it has longer hospitalization time,high cost,easily nerve damage intraoperative,longer postoperative recovery time and more respiratory complications,contraindication for with underlying disease elderly patients,etc.These factors limit the application of general anesthesia.In order to reduce the pain with the vertebral fracture patient,less cost and shorter hospitalization time in PKP,develop the minimally invasive technology better,we not only should pay more attention to and deal with intraoperative and postoperative pain,but also find a better anesthetic method replacing the existing anesthesia.objective: By comparing only 1% lidocaine hydrochloride from the skin to the puncture point of vertebral zygopophysis periosteum infiltration anesthesia method(group B)and adding injection of 1% lidocaine hydrochloride(5 ml)into vertebral body on the basis of the local anesthesia in group B anesthesia method(group A),whether cement leakage,intraoperative vital signs and emotional expression changes.The visual analogue scale(VAS)scores were recorded as the observation indexes at the moment of pre-operation,intraoperative balloon expansion,injection of bone cement,immediately post-operation,postoperative 6h to estimate the level of pain,as well as hospitalization time(days),operation time(minutes)and bone cement injection quantity(ml).Method: A total of 45 patients who were treated by PKP were selected from December 2016 to June 2017 in The First Affiliated Hospital Of Dalian Medical University spine surgery.A total of 14 cases of men,with an average age of 72.2 years old,women in 31 cases with an average age of 72.3 years old;A total of 53 vertebral bodies,including thoracic 17(one T7,one T10,two T8,two T9,three T11,eight T12),lumbar 36(seventeen L1,nine L2,six L3,four L4).Divided into group A and group B,group A injection of 1% lidocaine hydrochloride(5 ml)into vertebral body anesthesia method,group B only 1% lidocaine hydrochloride from the skin to vertebral periosteum infiltration anesthesia method.A total of 24 patients with group A,A total of 29 vertebral bodies(thoracic 11,lumbar 18),among them 10 cases male and 14 cases female,aged from 49 to 87,with an average of 71 years old;vertebral metastases 1 case,burst fracture 1 case,compression fractures 22 cases;single vertebral body fracture 20 cases,two vertebral bodies fracture 3 cases,three vertebral body fracture 1 case;group B patients 21 cases,a total of 24 vertebral bodies(thoracic 6,lumbar 18),among them 4 cases male,17 cases female,aged from 49 to 96,with an average of 74 years old;vertebral metastases in 1 case,compression fractures 20 cases;single vertebral body fracture 19 cases,two vertebral bodies fracture 1 case,three vertebral body fracture 1 case.All the patients had different degrees of pain before operation,no lower limb nerve symptom,performed bilateral pedicle puncture in PKP.Recorded whether cement leakage,intraoperative vital signs and emotional expression changes and the visual analogue scale(VAS)scores at the moment of pre-operation,intraoperative balloon expansion,injection of bone cement,immediately post-operation,postoperative 6h.Hospitalization time(days),operation time(minutes)and bone cement injection quantity(ml)had been recorded.Results: All of the patients were safely completed operation,and bone cement leakage occurred in the two cases without neurological symptoms.Group B someone shouted and cried when expanded the balloon intraoperation and other one had increased heart rate and bigger blood pressure variability.Group A patients were relatively stable and words of comfort effectively.There were no significant difference between 2 groups in preoperative general information and VAS score(P > 0.05).At the moment of balloon expansion the VAS scores of the two groups of A and B were 7.28±0.591 and 8.08± 0.50 respectively,and the differences were statistically significant(P < 0.05).At the moment of injection of bone cement the VAS scores of both groups A and B were 7.28±0.751 and 8.17±0.482 respectively,and the differences were statistically significant(P < 0.05).At the moment of immediately post-operation the VAS scores of the A&B two groups were 2.46±1.021 and 3.57±3.944 respectively,but the differences were no statistically significant(P >0.05).At the moment of postoperative 6h the VAS scores of the A&B two groups were 0.67±0.637 and 0.67±0.966 respectively,and the differences were statistically significant(P < 0.05).The hospitalization(days)and operation time(minutes)of the A&B two groups were 5.96±1.488&6.10±1.136 and 34.58±8.958&31.43±7.928 respectively,but the differences were no statistically significant(P >0.05).The amounts of bone cement injection(ml)in both groups A and B were 9.345±2.5288 and 7.958±1.5528 respectively,but the differences were no statistically significant(P >0.05).conclusion: Injection of 1% lidocaine hydrochloride(5 ml)into vertebral body anesthesia method can effectively relieve patients pain in intraoperation and post-operation.It not only has the advantages of local anesthesia: shorter operation time,less postoperative complications,shorter hospitalization time,low cost,but also effectively reduce the patient's pain,making patient's vital signs in intraoperative more smoothly and better communication between patients and surgeons. |
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