Scholarlink

Background <p>Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity in the aging population. Percutaneous kyphoplasty (PKP) effectively stabilizes fractures and provides rapid pain relief, but the optimal local anesthetic regimen for maximizing intraoperative comfort and early functional recovery remains undefined. This study compared the effectiveness of lidocaine alone versus a lidocaine–ropivacaine mixture for intraoperative analgesia and early postoperative recovery in patients undergoing PKP under local anesthesia only.</p> Methods <p>This was a single-center, retrospective cohort study of patients who underwent PKP for single-level OVCF between January 2022 and January 2024. Patients received either 1% lidocaine (L group) or a 1:1 mixture of 1% lidocaine and 0.5% ropivacaine (LR group) for local infiltration anesthesia. The total administered volume was standardized to 10&#xa0;mL in all patients. To mitigate selection bias, we performed 1:1 propensity score matching (PSM) based on age, sex, body mass index, baseline pain score, and fracture level. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) at predefined intraoperative and postoperative time points, time to first ambulation, and the Oswestry Disability Index (ODI) at 48&#xa0;h postoperatively. Secondary outcomes included the need for rescue analgesia, incidence of adverse events, and patient satisfaction. Effect sizes (Cohen’s <i>d</i>) and 95% confidence intervals (CIs) were calculated for primary comparisons. To assess robustness to unmeasured confounding, the <i>E</i>-value was calculated for the primary outcome.</p> Results <p>From an initial cohort of 120 patients, PSM yielded 51 well-balanced pairs (standardized mean differences &lt; 0.1 for all covariates). The LR group demonstrated significantly lower VAS scores during balloon dilation (mean difference [MD] = − 0.77, 95% CI [− 1.15, − 0.39], <i>P</i> = 0.0001, Cohen’s <i>d</i> = 0.83) and cement injection (MD = − 0.60, 95% CI [− 0.96, − 0.24], <i>P</i> = 0.001, <i>d</i> = 0.65). Postoperative VAS scores were consistently lower in the LR group at all time points (all <i>P</i> ≤ 0.001), with the largest effect observed at 6&#xa0;h postoperatively (dynamic VAS MD = − 0.76, 95% CI [− 1.14, − 0.38], <i>P</i> = 0.0002, <i>d</i> = 0.51). Time to first ambulation was significantly shorter in the LR group (14.0 ± 3.3 vs. 24.9 ± 3.7&#xa0;h, MD = − 10.9&#xa0;h, 95% CI [− 12.3, − 9.5], <i>P</i> &lt; 0.0001, <i>d</i> = 3.13). The <i>E</i>-value for the ambulation outcome was 5.74 (CI limit: 4.94), indicating substantial robustness to unmeasured confounding. The ODI score at 48&#xa0;h was also significantly lower in the LR group (37.4 ± 3.0 vs. 41.1 ± 3.4, MD = − 3.7, 95% CI [− 5.0, − 2.4], <i>P</i> &lt; 0.0001, <i>d</i> = 1.16). The need for intraoperative rescue analgesia was significantly lower in the LR group (17.6% vs. 37.3%, <i>P</i> = 0.03). No serious adverse events occurred in either group. Patient satisfaction was significantly higher in the LR group (96.1% vs. 80.4%, <i>P</i> = 0.02).</p> Conclusion <p>In this propensity score-matched retrospective cohort study, the use of a standardized 10&#xa0;mL lidocaine–ropivacaine mixture for local infiltration anesthesia in PKP performed under local anesthesia only was associated with significantly improved intraoperative and early postoperative analgesia, faster time to ambulation, and higher patient satisfaction compared to lidocaine alone, without an increase in adverse events. The E-value analysis suggests the observed association is moderately robust to unmeasured confounding. However, given the retrospective design and inherent potential for residual bias, these findings should be considered hypothesis-generating. Prospective randomized trials are warranted to confirm these findings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Comparative effectiveness of lidocaine versus lidocaine–ropivacaine combination for intraoperative analgesia and recovery in percutaneous kyphoplasty under local anesthesia only: a propensity score-matched retrospective cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月27日

查看全文
  • Yang Peng,
  • He Renjian,
  • Yang Fuguo

摘要

Background

Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity in the aging population. Percutaneous kyphoplasty (PKP) effectively stabilizes fractures and provides rapid pain relief, but the optimal local anesthetic regimen for maximizing intraoperative comfort and early functional recovery remains undefined. This study compared the effectiveness of lidocaine alone versus a lidocaine–ropivacaine mixture for intraoperative analgesia and early postoperative recovery in patients undergoing PKP under local anesthesia only.

Methods

This was a single-center, retrospective cohort study of patients who underwent PKP for single-level OVCF between January 2022 and January 2024. Patients received either 1% lidocaine (L group) or a 1:1 mixture of 1% lidocaine and 0.5% ropivacaine (LR group) for local infiltration anesthesia. The total administered volume was standardized to 10 mL in all patients. To mitigate selection bias, we performed 1:1 propensity score matching (PSM) based on age, sex, body mass index, baseline pain score, and fracture level. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) at predefined intraoperative and postoperative time points, time to first ambulation, and the Oswestry Disability Index (ODI) at 48 h postoperatively. Secondary outcomes included the need for rescue analgesia, incidence of adverse events, and patient satisfaction. Effect sizes (Cohen’s d) and 95% confidence intervals (CIs) were calculated for primary comparisons. To assess robustness to unmeasured confounding, the E-value was calculated for the primary outcome.

Results

From an initial cohort of 120 patients, PSM yielded 51 well-balanced pairs (standardized mean differences < 0.1 for all covariates). The LR group demonstrated significantly lower VAS scores during balloon dilation (mean difference [MD] = − 0.77, 95% CI [− 1.15, − 0.39], P = 0.0001, Cohen’s d = 0.83) and cement injection (MD = − 0.60, 95% CI [− 0.96, − 0.24], P = 0.001, d = 0.65). Postoperative VAS scores were consistently lower in the LR group at all time points (all P ≤ 0.001), with the largest effect observed at 6 h postoperatively (dynamic VAS MD = − 0.76, 95% CI [− 1.14, − 0.38], P = 0.0002, d = 0.51). Time to first ambulation was significantly shorter in the LR group (14.0 ± 3.3 vs. 24.9 ± 3.7 h, MD = − 10.9 h, 95% CI [− 12.3, − 9.5], P < 0.0001, d = 3.13). The E-value for the ambulation outcome was 5.74 (CI limit: 4.94), indicating substantial robustness to unmeasured confounding. The ODI score at 48 h was also significantly lower in the LR group (37.4 ± 3.0 vs. 41.1 ± 3.4, MD = − 3.7, 95% CI [− 5.0, − 2.4], P < 0.0001, d = 1.16). The need for intraoperative rescue analgesia was significantly lower in the LR group (17.6% vs. 37.3%, P = 0.03). No serious adverse events occurred in either group. Patient satisfaction was significantly higher in the LR group (96.1% vs. 80.4%, P = 0.02).

Conclusion

In this propensity score-matched retrospective cohort study, the use of a standardized 10 mL lidocaine–ropivacaine mixture for local infiltration anesthesia in PKP performed under local anesthesia only was associated with significantly improved intraoperative and early postoperative analgesia, faster time to ambulation, and higher patient satisfaction compared to lidocaine alone, without an increase in adverse events. The E-value analysis suggests the observed association is moderately robust to unmeasured confounding. However, given the retrospective design and inherent potential for residual bias, these findings should be considered hypothesis-generating. Prospective randomized trials are warranted to confirm these findings.