Efficacy and Safety of Ultrasound-Guided Erector Spinae Plane Block at Different Injection Depths for Percutaneous Kyphoplasty: A Randomized Controlled Trial.

Abstract

<h4>Objective</h4>To compare the analgesic efficacy and safety of deep, superficial and combined deep-superficial erector spinae plane block (ESPB) combined with subanesthetic-dose esketamine in patients undergoing percutaneous kyphoplasty (PKP).<h4>Patients and methods</h4>A total of 120 elderly patients with osteoporotic vertebral compression fractures and undergoing elective PKP were randomly divided into three groups (n=40 each): a deep ESPB group (D), a superficial ESPB group (S) and a combined deep-superficial ESPB group (C). All patients received intravenous esketamine (0.125 mg/kg) preoperatively. We recorded intraoperative and postoperative Visual Analogue Scale (VAS) scores, hemodynamic parameters, the onset time for sensory block, rescue analgesia requirements and adverse reactions.<h4>Results</h4>The combined group exhibited significantly lower cumulative intraoperative pain (AUC: 0-4), fewer administrations of rescue analgesia, and more stable hemodynamics than the two single-depth groups (P<0.01 for all). Differences in postoperative analgesia were only observed at 6 hours, with no significant differences at 12 and 24 hours. No significant difference was found between the three groups in terms of the incidence of adverse reactions.<h4>Conclusion</h4>Combined deep and superficial ESPB combined with subanesthetic-dose esketamine provides superior intraoperative analgesia and hemodynamic stability for patients with PKP, with a safety profile that is similar to single-depth blocks.

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