Thoracic paravertebral block versus local infiltration anesthesia for percutaneous kyphoplasty to treat osteoporotic vertebral compression fractures combined with intercostal neuralgia: a randomized controlled trial.

Background: Percutaneous kyphoplasty (PKP) is an effective treatment for osteoporotic vertebral compression fractures (OVCFs) and provides effective pain relief; however, its efficacy is questionable in patients with thoracic OVCFs combined with intercostal neuralgia (IN). This study aims to compare the efficacy and safety of thoracic paravertebral nerve block (TPVB) and local infiltration (LI) anesthesia for PKP to treat thoracic OVCFs combined with IN.

Methods: Patients with OVCFs combined with IN scheduled to undergo PKP between January 2021 and June 2022 were randomized into the following groups: TPVB and LI. Intraoperative visual analog scale (VAS) score, patients' anesthesia satisfaction (PAS) score, mean arterial pressure (MAP), and heart rate (HR) were recorded. Follow-up consultations were scheduled at 1 day, 1 month, 3 months, and 6 months postoperatively, recording the demographic characteristics, including surgical information, and complications observed in both groups. The clinical evaluation parameters included the VAS score, Oswestry Disability Index (ODI), and Short Form (SF)-36 score. Radiological evaluation parameters included the anterior vertebral body height ratio (AVBHR) and Cobb's angle of the injured vertebra.

Results: Sixty patients were enrolled (30 in each group), with similar clinical and demographic characteristics. The mean intraoperative VAS scores from time points T1 to T5 were significantly lower in the TPVB group [2 (1-2), 3 (2-3), 3 (3-4), 3 (2-3), and 2 (2-2)] than in the LI group [2 (2-3), 4 (3-4), 4 (3-5), 3.5 (3-4), and 3 (3-3)]. The PAS scores were significantly higher in the TPVB group [3(3-3)] than in the LI group [2(2-3)]. The TPVB group demonstrated significantly better clinical outcomes than that of the LI group at 1 day postoperatively, as evidenced by higher VAS, ODI, and SF-36 bp scores. The corresponding scores in the TPVB group were 2 (2-2), 20.47 ± 3.14, and 84 (84-84), respectively, and in the LI group were 3 (3-3), 22.53 ± 4.20, and 84 (74-84), respectively (p < 0.05). No statistically significant differences in radiological terms were observed between the two groups. No postoperative complications were observed in either group.

Conclusions: Compared to LI, TPVB provided better intraoperative and postoperative short-term analgesia with an equivalent safety profile when administered to patients with OVCFs combined with IN.

Trial Registration: ChiCTR2000035034, 28/07/2020, https//www.chictr.org.cn.