Assessment of Ultrasound-Guided Modified Erector Spinae Plane Block for Clinical Anesthesia in Geriatric Spinal Surgery

Objective: To compare the clinical anesthetic effects of ultrasound-guided traditional erector spinae plane block (ESPB) with those of modified ESPB (layer-by-layer infiltration erector spinae plane block) in elderly spinal fracture surgery. Methods: From January to December 2023, eighty patients diagnosed with geriatric spinal fractures underwent ESPB surgery at Guangzhou University of Chinese Medicine's Shenzhen Hospital (Futian). The patients were randomly divided into the ESPB layer-by-layer infiltration group (Group M) and the traditional ESPB group (Group E), with 40 participants in each. The study compared ESPB operation time and percutaneous kyphoplasty (PKP) procedure time between the groups, as well as the intraoperative administration of additional intravenous analgesic medicines and the assessment of blood oxygen, mean arterial pressure (MAP), heart rate (HR), and pain scores at before anesthesia (T0), 20 minutes after blockade (T1), skin incision (T2), and following bone cement implantation (T3). Results: The use of additional intraoperative sufentanil in ESPB revealed significant differences between the groups (p < 0.001). From T0 to T3, there were statistically significant differences in HR, MAP, and numerical rating scale scores between the groups (p < 0.05). There were also significant differences in MAP and NRS scores between the traditional and modified ESPB groups (p < 0.05). Conclusion: Modified ESPB builds upon traditional ESPB by continuing to infiltrate anesthesia layer by layer along the direction of the erector spinae fascia after the puncture needle reaches the ultrasound- guided nerve block plane. This method effectively enhances intraoperative analgesia and sedation in spinal compression surgery, improving the quality of anesthesia in senior spinal surgery. Copyright (c) 2025, Taiwan Society of Geriatric Emergency & Critical Care Medicine.