Sesay Musa, Tauzin-Fin Patrick, Jeannin Aude, Vignes Jean Rodolphe, Dousset Vincent, Maurette Pierre
Department of Anesthesiology, Centre Hospitalier Universitaire Pellegrin, Place Amélie Raba Léon, Bordeaux, France.
J Neurosurg Anesthesiol. 2009 Apr;21(2):165-9. doi: 10.1097/ANA.0b013e3181920d3b.
Percutaneous vertebroplasty (PVP) consists of injecting small quantities of orthopedic cement to consolidate pathologic vertebral bodies. The procedure is brief but painful during vertebral puncture and cement injection requiring either general anesthesia or monitored anesthesia care with opioids. The optimal dose of alfentanil in this setting is unknown. Therefore, we sought to determine its median effective dose (ED50, or analgesic efficacy in 50% of patients) during PVP in none intubated, spontaneously breathing patients. After approval and informed consent of the Institutional Review Board, 50 patients (American Society of Anesthesiologists II-III, age 50 to 80, weight: 53 to 82 kg) with osteoporotic vertebral fractures were enrolled. The patients were premedicated with oral hydroxyzine 100 mg and had skin infiltration with 50 mg lidocaine before vertebral puncture. The prone position was adopted and oxygen was provided via a facemask. Noninvasive cardiorespiratory variables were monitored. Pain was evaluated by a numerical pain scale (NPS) where 0 represents no pain and 10 the worst tolerable pain. Alfentanil infusion was started 30 minutes before vertebral puncture. The initial dose was 2.0 mg/h. Thereafter, a 0.05 mg/h decrease or increase was applied to the next patient if analgesia was effective (NPS: 3 or less) or not (NPS>3) according to the Dixon method. The bootstrap resampling technique was used to calculate the ED50 and its 95% confidence limits. The latter was 1.05 mg/h (95% confidence interval, 1.0-1.2). Transient apnea (n=2) and nausea/vomiting (n=3) were observed. Given the median body weight of the patients (65 kg), we conclude that 0.27 microg kg/min of alfentanil provides effective analgesia for PVP under monitored anesthesia care.
PVP consists of injecting small quantities of orthopedic cement to consolidate pathologic vertebral bodies. The median effective dose (ED50) for pain relief during vertebral puncture and cement injection is 1.05 (95% confidence interval, 1.0-1.2) mg/h when infusion is started 30 minutes before the procedure. Given the median body weight of our study population (65 kg), this dose corresponds to 0.27 microg kg/min.
经皮椎体成形术（PVP）是通过注射少量骨科骨水泥来加固病变椎体。该手术操作时间短，但在椎体穿刺和骨水泥注射过程中会产生疼痛，这需要全身麻醉或使用阿片类药物的监护下麻醉。在这种情况下，阿芬太尼的最佳剂量尚不清楚。因此，我们试图确定在非插管、自主呼吸的患者进行PVP手术期间其半数有效剂量（ED50，即50%患者的镇痛效果）。经机构审查委员会批准并获得知情同意后，纳入了50例患有骨质疏松性椎体骨折的患者（美国麻醉医师协会II - III级，年龄50至80岁，体重：53至82千克）。患者术前口服100毫克羟嗪，并在椎体穿刺前用50毫克利多卡因进行皮肤浸润麻醉。采用俯卧位，通过面罩提供氧气。监测无创心肺变量。通过数字疼痛量表（NPS）评估疼痛，其中0表示无疼痛，10表示难以忍受的最严重疼痛。在椎体穿刺前30分钟开始输注阿芬太尼。初始剂量为2.0毫克/小时。此后，根据迪克森方法，如果镇痛有效（NPS：3或更低）或无效（NPS>3），则对下一位患者减少或增加0.05毫克/小时的剂量。采用自助重采样技术计算ED50及其95%置信区间。后者为1.05毫克/小时（95%置信区间，1.0 - 1.2）。观察到短暂性呼吸暂停（n = 2）和恶心/呕吐（n = 3）。考虑到患者的中位体重（65千克），我们得出结论，在监护下麻醉时，0.27微克/千克/分钟的阿芬太尼可为PVP提供有效的镇痛作用。
PVP是通过注射少量骨科骨水泥来加固病变椎体。在手术前30分钟开始输注时，椎体穿刺和骨水泥注射期间缓解疼痛的半数有效剂量（ED50）为1.05（95%置信区间，1.0 - 1.2）毫克/小时。考虑到我们研究人群的中位体重（65千克），该剂量相当于0.27微克/千克/分钟。
