Background and Aims Percutaneous vertebroplasty is a minimally invasive technique and typically, these interventions involve local anaesthesia in association with moderate sedation or general anesthesia. ESB (Erector Spinae Plane Block) is an interfascial plane block with growing applications in perioperative analgesia for a number of procedures. However, there are no reports on the use of ESB as an anaesthetic technique for percutaneous spinal surgery. This report describes the application of bilateral ESB for lumbar vertebroplasty in a patient with an anticipated difficult airway.

Case description A 65-year-old woman with difficult airway stigma presented for L3 percutaneous vertebroplasty due to a compression fracture. Avoidance of sedation was preferably, given the challenging airway conditions. Bilateral ESB was performed, using a total of 40 mL of 0.375% ropivacaine, 20 minutes prior to the beginning of surgery. Surgery proceeded successfully and no other medication was required. The recovery period was uneventful and the patient did not require additional analgesia.

Discussion The standard anesthetic technique for vertebroplasty procedure is moderate sedation or monitored anesthesia care in association with local anesthetic. However, although this is a minimally invasive procedure, patients experience significant perioperative pain. In this case, a predictable difficult airway limited the use of opioids and other respiratory depressant drugs.

Conclusions To avoid intraprocedural discomfort, ESB proved to be sufficient anaesthesia for a successful intervention and advantageous for post-procedural pain relief. Therefore, we highlight ESB as a single, reliable and useful anaesthesia technique for percutaneous vertebroplasty when airway management might be difficult.