Comparison of efficacy of ultrasound guided erector spinae plane block as a post operative analgesia using two different local anaesthetic in percutaneous nephrolithotomy surgery: Randomized comparative end-point blinding study

Aim: To compare the postoperative analgesic efficacy of 0.25% levobupivacaine and 0.375% ropivacaine in ESPB for patients undergoing unilateral percutaneous nephrolithotomy (PCNL) under subarachnoid block (SAB). Methods: This study was conducted at a tertiary care center in Barabanki over 18 months after ethical committee approval. Sixty-two patients, aged 18-65 years, classified as ASA I/II, were randomized into two equal groups: Group L (0.25% levobupivacaine, 25 mL) and Group R (0.375% ropivacaine, 25 mL). ESPB was administered post-SAB using ultrasound guidance at the T10 level. Postoperatively, patients were assessed for pain using the Visual Analog Scale (VAS) at rest and during dynamic movements at scheduled intervals for 24 hours. Hemodynamic parameters, time to first rescue analgesia, total analgesic consumption, and side effects were recorded. Results: VAS scores at rest and dynamic movement were significantly lower in Group L compared to Group R at multiple time points, particularly beyond 6 hours postoperatively (p<0.05). The mean time to first rescue analgesia was significantly longer in Group L (17.32±1.49 hours) compared to Group R (9.32±1.01 hours) (p<0.001). Total 24-hour analgesic consumption was significantly lower in Group L (130.90±14.93 mg) than in Group R (149.45±8.21 mg) (p<0.001). Adverse effects were comparable between the groups. Conclusion: ESPB with 0.25% levobupivacaine provided superior postoperative analgesia compared to 0.375% ropivacaine in PCNL patients, as evidenced by lower VAS scores, prolonged time to first rescue analgesia, and reduced total analgesic consumption. Both drugs exhibited a comparable safety profile. Levobupivacaine may be a preferred choice for prolonged postoperative pain relief in PCNL surgery.