Ultrasound-Guided Paravertebral Nerve Block in Percutaneous Vertebroplasty: A Retrospective Analysis

Technical Summary: Ultrasound-Guided Paravertebral Nerve Block in Percutaneous Vertebroplasty

Problem Statement
Osteoporotic vertebral compression fractures (OVCF) are increasingly common among the aging population, often requiring percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) for pain relief and mobility restoration. However, anesthetic management for these procedures presents significant challenges. The patient population is typically elderly with comorbidities (e.g., hypertension, coronary heart disease) and must remain in a prone position. While local infiltration anesthesia is simple to perform, it often provides inadequate analgesia during deep surgical maneuvers like vertebral puncture and pressurized bone cement injection. This insufficiency can lead to patient pain, restlessness, poor cooperation, and significant hemodynamic fluctuations (tachycardia and hypertension) due to sympathetic activation. Although paravertebral nerve block (PVB) offers a potential solution by providing segmental somatic and sensory blockade, systematic retrospective studies comparing its efficacy against local anesthesia in this specific context remain limited.

Methodology
This study is a single-center, retrospective cohort analysis conducted at Hangzhou Xiaoshan District Traditional Chinese Medicine Hospital between July 2021 and July 2026. The study population consisted of 84 patients with thoracolumbar OVCF who underwent PVP.

• Grouping: Patients were divided into two groups based on their anesthesia protocol:
  • Observation Group (n=42): Received bilateral ultrasound-guided paravertebral nerve block (PVB) combined with local infiltration anesthesia.
  • Control Group (n=42): Received simple local infiltration anesthesia alone.
• Intervention Details:
  • PVB Technique: Under real-time ultrasound guidance (6–13 MHz linear probe), a needle was advanced into the paravertebral space (between the endothoracic fascia and parietal pleura) at the target surgical level. Local anesthetic (0.15%–0.25% ropivacaine, 20–30 mL total) was injected in divided doses. Sensory blockade was confirmed via pinprick assessment before surgery.
  • Local Anesthesia: Both groups received 1% lidocaine (5–10 mL) for layer-by-layer infiltration at the incision and puncture trajectory.
• Outcome Measures: The study compared intraoperative mean arterial pressure (MAP) and heart rate (HR), operative time, postoperative Visual Analogue Scale (VAS) pain scores (at 0, 6, 12, and 24 hours), length of hospital stay (LOS), and the incidence of postoperative complications (e.g., nausea, vomiting, bone cement leakage).
• Statistical Analysis: Data were analyzed using SPSS 26.0 or R. Continuous variables were compared using t-tests or Mann-Whitney U tests, while categorical variables were analyzed using chi-square or Fisher's exact tests. A P-value < 0.05 was considered statistically significant.

Key Results
The retrospective analysis yielded the following statistically significant findings (P < 0.05) favoring the ultrasound-guided PVB group:

• Hemodynamic Stability: The PVB group exhibited significantly lower intraoperative MAP (116 ± 13.2 vs. 132 ± 14.7 mmHg) and HR (81 ± 8.1 vs. 87 ± 6.3 bpm) compared to the control group, indicating reduced stress response.
• Pain Control: Postoperative VAS scores were significantly lower in the PVB group at all measured time points (T0: 1.93 vs. 2.48; T1: 1.86 vs. 2.24; T2: 1.64 vs. 2.07; T3: 0.64 vs. 1.29).
• Operative Efficiency: The operative time was significantly shorter in the PVB group (32.4 ± 12.37 min vs. 41.1 ± 6.12 min).
• Hospital Stay: Patients in the PVB group had a significantly shorter length of hospital stay (8.9 ± 5.28 days vs. 5.2 ± 2.78 days).
• Safety: There was no statistically significant difference in the incidence of postoperative complications (e.g., nausea/vomiting, bone cement leakage) between the two groups (P = 0.71).

Significance and Claims
The authors conclude that ultrasound-guided paravertebral nerve block is a superior anesthetic strategy for PVP in thoracolumbar fractures compared to local anesthesia alone. The study claims that this technique:

1. Stabilizes Vital Signs: By blocking the transmission of nociceptive pain signals at the source (spinal nerves), PVB prevents the sympathetic surge associated with surgical trauma, thereby reducing the risk of perioperative cardiovascular adverse events in high-risk elderly patients.
2. Enhances Surgical Efficiency: Superior analgesia allows patients to maintain a stable position and cooperate effectively, reducing the need for surgeons to pause or adjust for patient movement, which shortens operative time.
3. Improves Recovery: Effective pain management facilitates early mobilization and functional recovery, leading to shorter hospital stays and better resource utilization.
4. Ensures Safety: The visualized approach minimizes the risk of blind puncture injuries, and the study found no increase in adverse events compared to local anesthesia.

The paper positions ultrasound-guided PVB as a valuable, safe, and efficient option worthy of promotion for optimizing anesthetic protocols in PVP surgery.