Percutaneous Vertebroplasty and Procedural Pain

BACKGROUND AND PURPOSE: No consensus exists regarding pain management during PV. In this study, we evaluated the effectiveness of local infiltration anesthesia as the only pain medication.

MATERIALS AND METHODS: From September 2008 to March 2009, 44 consecutive patients (35 women and 9 men; mean age, 74 years) with symptomatic OVCFs were included in the study. Lidocaine was infiltrated to the skin and the periosteum of the pedicle. After PV, patients indicated pain sensation on a VAS. In addition, patients indicated the most painful moment during the procedure: lidocaine infiltration, placing the needles, or cement injection. Finally, patients were asked whether pain medication during the procedure was sufficient. After the procedure the surgeon was asked to judge the expected VAS score of the patient.

RESULTS: Mean VAS score was 5.7 (median, 6; range, 1–10). Seventeen of 44 patients (39%) indicated that lidocaine infiltration was insufficient for procedural pain reduction. The mean VAS score of these patients was 7.3 (range, 5–10). Placing the needles was specified as most painful moment in 29 patients (66%), lidocaine infiltration in 11 (25%), and cement injection in 4 (9%). Surgeons' expectations of patients' VAS scores were a mean of 3.3 (median, 3; range, 1–6).

CONCLUSIONS: For a substantial proportion of patients, local infiltration anesthesia was not sufficient for pain reduction during PV. The severity of pain experienced by the patient is usually not appreciated correctly by the surgeon.