Ultrasound-Guided Erector Spinae Plane Block Vs. Intramuscular Piroxicam in The Management of Renal Colic Pain: A Comparative Study

Abstract Background: Renal colic is a common urological emergency often causing severe flank pain that radiates to the groin, typically managed with nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. Ultrasound-guided Erector Spinae Plane Block (ESPB) has recently gained attention as a regional anesthesia technique for acute pain management. This study compares the efficacy and safety of ESPB versus intramuscular (IM) Piroxicam in patients with renal colic presenting to the Emergency Department. Methods: A prospective, cross-sectional comparative study was conducted in a tertiary care center from September 2022 to March 2024. Adult patients aged 18–45 years presenting with moderate to severe renal colic (NRS score 5–10) were recruited. Patients self-selected either ESPB (Group A) or IM Piroxicam (Group B) after providing informed consent. Pain scores (Numeric Rating Scale, NRS) and vital parameters were recorded at 0, 15, 30, 45, and 60 minutes post-intervention. Need for rescue analgesia and any adverse events were also documented. Statistical analysis was performed using appropriate tests with p < 0.05 considered significant. Results: A total of 50 patients (25 in each group) were enrolled. Both groups demonstrated a significant reduction in pain at all-time points compared to baseline (p < 0.05). However, ESPB consistently showed lower mean NRS scores than Piroxicam at 15, 30, 45, and 60 minutes (p < 0.05). Although 4 patients in the Piroxicam group required rescue analgesia, none were needed in the ESPB group (p = 0.118). No major complications or adverse events were observed in either group. Conclusion: Ultrasound-guided ESPB appears to offer superior analgesia compared to IM Piroxicam for renal colic, with faster pain relief and a lower likelihood of requiring rescue analgesia. Further large-scale, randomized controlled trials are recommended to validate these findings.