Quadratus Lumborum Block versus Erector Spinae Plane Block for Pain Management during Shock Wave Lithotripsy: Prospective Randomized Controlled Study

Background: Urinary tract calculi affect approximately 12% of patients, often causing significant pain during shock wave lithotripsy (SWL). This study aims to compare the analgesic efficacy of the Quadratus Lumborum Block (QLB) and the Erector Spinae Plane Block (ESPB) in managing pain during SWL.Methods: This prospective randomized controlled trial involved 156 patients aged 18-60 with renal pelvic stones <2.5 cm. Participants were randomized into three groups: QLB, ESPB, and control. Pain levels were assessed using the Visual Analog Scale (VAS) at multiple time points, and opioid consumption was recorded.Results: The QLB group demonstrated significantly lower median VAS scores compared to the control group at all points (p < 0.01). The ESPB group also showed improved pain relief compared to controls, particularly at 10-20 minutes (p < 0.01). The first analgesic request was significantly delayed in the QLB group (median 25 min) compared to the ESPB (15 min) and control (12.5 min) groups (p < 0.001). Both regional blocks resulted in reduced opioid consumption.Conclusions: Both QLB and ESPB are effective analgesic techniques for managing pain during SWL, with QLB providing superior pain control and opioid-sparing effects. These findings support the implementation of regional anesthesia protocols to enhance patient comfort and treatment outcomes in SWL procedures.