Perioperative pain relief in percutaneous nephrolithotomy: A randomised trial of ultrasound-guided erector spinae plane block compared to peri-tubal anaesthetic infiltration

ABSTRACT Objective: The aim of this study is to compare peri-tubal local anaesthetic (LA) infiltration with ultrasound-guided erector spinae plane block (ESPB) as an analgesic technique for percutaneous nephrolithotomy (PCNL) surgeries. The study hypothesised that patients receiving ESPB would require postoperative rescue analgesics later as compared to those receiving LA infiltration. Methods: The study is a prospective, single-blinded, randomised clinical trial. Fifty-two adult patients undergoing unilateral PCNL were randomly allocated into the ESPB group ( n = 26) or the LA infiltration group ( n = 26). The block group received ultrasound-guided ESPB with 0.4 ml/kg of 0.5% ropivacaine preoperatively, while the LA infiltration group received 0.4 ml/kg of 0.5% ropivacaine in the peri-tubal track in two divided doses. The study’s primary outcome was the time to first rescue analgesia, which was calculated from the patient’s arrival in the post-anaesthesia care unit to the first patient-controlled analgesia pump bolus dose. Results: The mean (standard deviation) time to first analgesia was 2.3 (0.48) h in the LA infiltration group and 20.7 (6.1) h in the ESPB group, with a difference in means of − 18.4 h (99% confidence interval, −21.8 to − 14.9; P < 0.001). Conclusion: Ultrasound-guided ESPB provides superior perioperative analgesia compared to peri-tubal LA infiltration in PCNL surgeries, offering significantly improved pain relief during movement in the ESPB group.