Percutaneous vertebroplasty in the management of osteoporotic vertebral compression fractures: initial experience.

INTRODUCTION: Vertebral compression fractures related to osteoporosis may cause persistent pain which impairs mobility and reduces the quality of life. Percutaneous vertebroplasty is a therapeutic interventional radiology procedure which is used in the management of pain relief in such fractures. It involves the injection of bone cement [polymethylmethacrylate (PMMA)] into the collapsed vertebrae under radiological guidance. This provides pain relief as well as increases the strength and stability of the vertebra. MATERIALS AND METHODS: A total of 16 patients with 17 osteoporotic compression fractures which were treated with percutaneous vertebroplasty over an 18-month period were studied. There were all women with the exception of 1 male patient. Their ages ranged from 61 to 87 years. The fracture sites were at the thoracolumbar junction from T12 to L3 levels. The majority of cases only required a unipedicular injection, with bipedicular injections in 3 cases. All cases were performed in the angiographic suite in the radiology departments, with biplanar fluoroscopy in one hospital. PMMA was injected in a semi-solid state under radiological guidance and screening into the collapsed vertebrae. RESULTS: All cases showed good technical success with no mortality or major complications. Only 2 cases had minor complications of cement leakage into the soft tissues of the back and adjacent disc space, respectively. There was sufficient pain relief in all patients and they were well enough to be discharged within 1 to 5 days after the procedure. Patients were followed up to evaluate the degree of long-term pain relief as well as analgesic usage. CONCLUSION: Percutaneous vertebroplasty is a new and minimally-invasive modality of treating pain in patients with osteoporotic compression fractures who are refractory to medical therapy. Under adequate imaging guidance, the risks of complications are minimal while the potential benefit to patients and their care-givers are significant.

Postoperative pain relief by preanesthetic administration of buprenorphine suppository in elective mastectomy

Seventy female patients scheduled for elective mastectomy were divided into three groups: Buprenorphine suppository (BPS) 0.4 mg group (n = 29); BPS 0.2 mg (n = 23) group; and control (scopolia extract and tannic acid suppository) group (n = 18). Suppositories were administered rectally to patients of each group one hour before induction of anesthesia. Plasma buprenorphine concentrations, sedation scores at entering the operating room, postoperative pain scores and side effects were evaluated. There were no significant differences in sedation effects of suppository among the three groups. Although there were significant differences in pain scores except at the time when patients left the operating room between BPS 0.2 mg group and the control group, postoperative pain relief in BPS 0.2 mg group was judged not enough. However, postoperative pain relief was more satisfactory in the BPS 0.4 mg group. Plasma concentrations of the BPS 0.4 mg group were higher than those of the BPS 0.2 mg group. Although nausea and vomiting were observed in 5 patients (17.2%) of the BPS 0.4 mg group and 4 patients (17.4%) of the BPS 0.2 mg group, respiratory depression and changes in blood pressure and heart rate were not observed in all groups. In conclusion, preanesthetic administration of the BPS 0.4 mg seemed to be useful for postoperative pain relief after elective mastectomy.

Fetal oxygen saturation during epidural and paracervical analgesia.

BACKGROUND: We wanted to assess changes in fetal oxygenation during maternal epidural or paracervical analgesia in labor. METHODS: A prospective, open and non-randomized study. Twenty healthy parturients were enrolled before they asked for pain relief. Informed consent was obtained. Fetal and maternal oxygen saturations were measured before and up to 1 h after the initiation of analgesia. Fetal oximetry was performed with the Nellcor N-400 oximeter+FS-14B fetal oxygen sensor (Nellcor Puritan Bennett, Pleasanton, California, USA). Maternal oximetry was done with Datex Satlite portable monitor (Datex, Finland). Visual analog scale was used for assessing pain relief. Two-way analysis of variance and students t-test were used for statistical analyses. RESULTS: Fetal oxygenation initially improved in both groups. The saturation then returned to baseline in both groups. In the epidural group, the values remained at baseline or slightly below, while in the paracervical group the saturation remained a little higher than baseline (p=0.009). No change was seen in maternal oxygenation or heart rate. No change in fetal heart rate was found either. Epidural block was superior to paracervical block with respect to pain relief (p=0.002). CONCLUSIONS: There was a small but significant difference in fetal oxygenation between epidural and paracervical groups during the observation period. The magnitude of the difference is hardly clinically significant. A larger, randomized study is needed to elucidate the mechanisms behind this finding.

The effect of labor pain relief medication on neonatal suckling and breastfeeding duration.

We examined the relationship of labor pain relief medications with neonatal suckling and breastfeeding duration in 129 mothers delivering vaginally. Suckling was measured using the Infant Breastfeeding Assessment Tool (IBFAT). Controlling for infant age, birthweight, and gender, infants of unmedicated mothers had higher IBFAT suckling scores than those of medicated mothers (x = 11.1 vs. x = 8.2 respectively, P = .001). IBFAT suckling scores for intravenous and epidural groups were similar (x = 8.5) while those who received a combination of both intravenous and epidural medications were lower (x = 6.4 +/- 2.96, P = .001). Mothers evaluated their breastfeeding similarly to nurse evaluators (Z = 9.39, P = .001). Breastfeeding duration did not differ between unmedicated and medicated groups; however, dyads with low IBFAT scores weaned earlier than those with medium or high scores. Labor pain relief medications diminish early suckling but are not associated with duration of breastfeeding through 6 weeks postpartum.