Abstract

Objective: To compare the clinical anesthesia outcomes of different segmental erector spinae plane block (ESPB) under ultrasound guidance in elderly patients undergoing percutaneous kyphoplasty (PKP).

Methods: From January to December 2022, patients who underwent ESPB-guided PKP at Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine were randomly divided into two groups: M group (ESPB anesthesia shifted 1–2 segments, 40 cases) and E group (ESPB anesthesia at the level of the fractured segment, 40 cases). The operation time for ESPB, PKP, additional intravenous analgesic dose during surgery, vital sign changes, and pain scores at various time points were compared between the two groups. SpO₂, MAP, and HR were assessed before anesthesia (T0), 20 minutes after blockade (T1), at skin incision (T2), and after bone cement implantation (T3). The Numerical Rating Scale (NRS) was used to evaluate pain scores at each interval. Postoperative complications, including nausea, vomiting, itching, cardiopulmonary complications, deep vein thrombosis, pulmonary embolism,
and mortality, were documented.

Results: No statistically significant differences were observed in operative time, surgery duration, and intraoperative additional analgesic use between the groups. HR, MAP, SpO₂, and NRS pain scores also showed no significant differences (p > 0.05) between the groups. For intragroup comparisons, from T1 to T3, Group E had significantly lower HR, MAP, SpO₂, and NRS scores than at T0 (p < 0.05). Therewas no statistically significant difference in the overall incidence rate of adverse reactions between the two groups.

Conclusion: While variations in needle segments for ESPB, as guided by ultrasound, did not significantly alter the anesthetic effect, they effectively improved analgesia and sedation in elderly patients with thoracolumbar vertebral compression fractures undergoing PKP. This method also reduces perioperative stress reactions and adverse events, enhancing the quality and safety of anesthesia.