#35939 Taming the tiger: sedation with remifentanil and midazolam for a five level vertebroplasty – a case report

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Background and Aims

Percutaneous vertebroplasty (PV) is a minimally invasive procedure for treating vertebral compression fractures. It may be done simultaneously to several vertebrae and these are often described under general anaesthesia. However, sedoanalgesia can be an effective alternative in cases where anaesthesia poses higher risks.

Methods

A 55-year-old female with osteoporotic vertebral fractures from T11 to L3 with severe chronic lower back pain was proposed for PV. She had a history of autoimmune hepatitis waiting liver transplantation and Crohn’s disease. PV was performed under remifentanil perfusion (0,15mcg/kg/min), midazolam bolus (1mg) and skin infiltration with lidocaine.

Results

The patient remained comfortable with stable vital signs and adequate pain relief. The use of remifentanil and midazolam provided effective sedoanalgesia, allowing successful completion of the five-level vertebroplasty with fast recovery. This case report highlights the feasibility and safety of analgesia of short-acting opioids even when combined with benzodiazepines for vertebroplasty and in patients with advanced chronic liver disease.

Conclusions

Analgesia with remifentanil for procedural sedation may be considered in selected cases, particularly for patients who are not suitable for general anaesthesia or intolerant to other sedatives, such as those with severe chronic liver disease. It may reduce procedure time, improve patient comfort and decrease recovery time.