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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Kyphoplasty is a minimally invasive procedure widely used for osteoporotic vertebral compression fractures (OVCF). Several anesthetic techniques (local, regional (paravertebral block (PRV)/Erector Spinae block (ESP) or general anesthesia (GA)) have been proposed to control pain during procedure.Methods A case series of 20 patients with OVCF underwent kyphoplasty between 2022 and 2024 was analyzed. Approval by IRB was requested (IIBSP-CCV-2025–80).Results 12 patients were women (60%) and 8 men (40%), with a mean age of 70.9 years (range 52–89) and ASA classification 2 in 12 patients (60%), 3 in 6 patients (30%), and 4 in 2 patients (10%). 16 patients received GA (80%), 2 patients ESP block (10%), and 2 combined anesthesia (GA + ESP) (10%). Most kyphoplasties were single-level thoracic, with an average duration of 30 minutes/level (range 30–45). ESP patients had optimal analgesic control, no rescue opioids, no complications. GA patients had poor analgesia, required rescue opioids, with 31% side effects. ESP and combined anesthesia patients discharged ≤ 24 hours. GA patients discharged at 24 h (31%), 48 h (31%), 72 h (31%), and one at day 14.Abstract P083 Figure 1Kyphoplasty procedureAbstract P083 Figure 2Needle approach for kyphoplastyAbstract P083 Figure 3Ultrasound thoracic ESP blockConclusions ESP block, alone or combined with GA, provides superior analgesic control and facilitates earlier hospital discharge in patients undergoing kyphoplasty compared to GA alone, which is associated with increased opioid requirements and complications, including delayed mobilization. The isolated ESP block may be considered the technique of choice for frailty patients with multiple comorbidities, as it achieves optimal analgesic, is easy to perform and thus avoids the risks associated to GA.