Comparison of the Effects of Ultrasound-Guided Erector Spinae Plane Block and Intramuscular Nonsteroidal Anti-Inflammatory Drug Administration on Intraoperative Analgesia and Patient Satisfaction During Extracorporeal Shock Wave Lithotripsy

Background/Objectives: To compare ultrasound-guided erector spinae plane block (ESPB) with an intramuscular nonsteroidal anti-inflammatory drug (IM NSAID) for analgesia during extracorporeal shock wave lithotripsy (ESWL). Methods: In this prospective, randomized, open-label trial, 90 patients scheduled for ESWL were allocated into three equal groups: ultrasound-guided ESPB at the T7 level; 75 mg of IM diclofenac sodium 30–45 min before the procedure; or no analgesic premedication (control). Pain was rated on the Visual Analog Scale (VAS) during the procedure, and hemodynamic variables, postprocedural analgesic requirement, and patient satisfaction were also recorded. Results: Mean intraoperative VAS scores differed among the groups (ESPB 2.96 ± 2.76, NSAID 4.47 ± 2.41, control 5.30 ± 2.15; p = 0.002, η2 = 0.14). At the first shock wave and at the 25th minute, VAS scores were lower in the ESPB group than in both other groups; at all remaining time points they were lower than in the control group. Early postprocedural analgesic requirement was highest in the control group (33.3% vs. 6.7% and 10.0%; p = 0.016), as it was at the 8th hour (p = 0.007). Satisfaction was lower in the control group than in the ESPB group (p = 0.018), with no significant difference between the control and NSAID groups after adjustment for multiple comparisons. Hemodynamic variables did not differ among the groups, and no complications were observed. Conclusions: ESPB gave better pain control during ESWL than no analgesia, and outperformed the IM NSAID regimen at the first shock wave and at the 25th minute. It also lowered the early analgesic requirement and improved satisfaction, which makes it a practical analgesic option for ESWL.