Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: Comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia

Abstract

Objective: Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with conventional local infiltration anes-thesia (CLIA) and extrapedicular infiltration anesthesia (EPIA) with respect to analgesic efficacy in patients who underwent elective PKP for VCF.Methods: A total of 90 American Society of Anesthesiologists (ASA) 1-3 patients were randomly assigned into 3 groups: group CLIA (n = 30), group EPIA (n = 30), and group ESP (n = 30). The same amount of local anesthetic mixture (6 mL lidocaine 1% and 14 mL bupiva-caine 0.5%) was used for regional anesthetic techniques in all groups. Fentanyl 0.1 μg/kg and midazolam 0.1 mg/kg were administered intravenously (IV) before prone positioning. Pain was evaluated using the visual analog scale (VAS) and sedation level using the Ramsay Sedation Scale (RSS) during the procedure. Primary outcome measure were VAS and RSS scores. Secondary outcome measures were hemodynamic changes and additional analgesic and sedative consumptions.Results: Mean baseline VAS scores were similar between groups (5.62 ± .39; P> .05). Intraoperative mean VAS scores were significantly higher in group CLIA compared to EPIA and ESP groups at all timepoints (P< .01). Time-bound changes in VAS scores showed a progres-sive decrease from baseline until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P< .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P< .01), while an increase was detected from baseline to the 20th minute in group CLIA (5.97 ± 1.35 to 7.07 ± 0.94; P< .01) that followed a decrease until the end of the procedure (3.47 ± 0.86; P< .01). The mean RSS scores were similar at baseline and at the end of the procedure in all groups (P> .01), but significantly lower in group CLIA compared to EPIA and ESP groups at the other timepoints (P< .001). Time-bound changes in RSS scores showed a progressive increase from baseline until the 20th minute of the procedure that followed a decrease until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P< .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P< .01).Conclusion: Better anesthetic advantages of ESP and EPIA over CLIA concerning intra-operative analgesia, analgesic and sedative con-sumption were demonstrated. ESP and EPIA can be used as a suitable anesthetic method in VCF patients undergoing single-level PKP, with stable hemodynamic parameters and analgesia in the intra-operative period.