Erector Spinae Plane Block versus Local Infiltration for Postoperative Pain Control in Percutaneous Nephrolithotomy: A Randomised Controlled Trial

Introduction: Percutaneous Nephrolithotomy (PCNL) is standard for large/complex renal stones, yet remains painful postoperatively. The Erector Spinae Plane Block (ESPB) may offer superior analgesia compared to conventional Local Anaesthetic Infiltration (LAI). Aim: To compare the efficacy of landmark-guided ESPB and LAI for postoperative analgesia following PCNL. Materials and Methods: This single-blind, randomised controlled trial was conducted at the Department of Anaesthesiology, Krishna Institute of Medical Sciences (KMISDU), Krishna Vishwa Vidyapeeth, Malkapur, Karad, Maharashtra, India, from March 2023 to August 2024. Sixty adults undergoing elective PCNL were randomly allocated (computer sequence, sealed envelopes) into two groups (n=30 each): Group A received landmark-guided ESPB with 20 mL 0.2% ropivacaine, and Group B received LAI with 20 mL 0.2% ropivacaine. The primary endpoints were time to first rescue analgesia, 24- hour tramadol consumption, and the number of rescue doses. Secondary endpoints were Postoperative Nausea and Vomiting (PONV), time to mobilisation, time to oral intake, patient satisfaction (0-10), and complications including local anaesthetic systemic toxicity. Analysis used Statistical Package for Social Sciences (SPSS) version 25.0; p-value <0.05 was significant. Results: All 60 patients were analysed (30 per group). Groups were comparable at baseline: age (42.3±9.6 vs 41.7±10.2 years), gender (male 60.0% vs 56.7%), weight (65.4±7.8 vs 64.7±8.1 kg), ASA I/II (66.7%/33.3% vs 73.3%/26.7%), and surgery duration (88.5±12.1 vs 89.3±13.4 min). ESPB significantly prolonged time to first rescue analgesia (8.10±1.41 vs 2.48±0.75 h; p-value <0.0001), reduced tramadol use (123.33±27.79 vs 205.00±39.86 mg; p-value <0.0001), and lowered rescue doses (1.67±0.66 vs 3.70±0.70; p-value <0.0001). Secondary outcomes favoured ESPB including lower PONV (10.0% vs 43.3%), earlier mobilisation (10.5±2.1 vs 18.7±3.3 h; p-value <0.01), faster oral intake (6.2±1.4 vs 12.3±2.5 h; p<0.01), and higher patient satisfaction (8.6±1.0 vs 6.3±1.4; p-value <0.001). No complications occurred in either group. Conclusion: Landmark-guided ESPB provided superior postoperative analgesia compared to LAI following PCNL, with delayed rescue need, lower opioid consumption, fewer rescue doses, faster recovery milestones, and greater satisfaction, without added complications. ESPB is a safe, opioid-sparing technique suitable for inclusion in multimodal analgesia protocols for PCNL.