Perioperative efficacy of erector spinae plane block in patients undergoing percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PCNL) may be associated with significant postoperative pain despite being a minimally invasive procedure. This study aimed to evaluate the effects of ultrasound-guided erector spinae plane block (ESPB) on perioperative opioid consumption, postoperative pain, and quality of recovery in patients undergoing PCNL. This prospective, randomized, assessor-blinded, controlled trial evaluated the effects of ultrasound-guided ESPB on postoperative analgesia and recovery quality in patients undergoing PCNL under general anesthesia. Patients scheduled for elective PCNL were randomly assigned to either the ESPB or control group. In the ESPB group, a unilateral ultrasound-guided ESPB was performed at the T10 level with 20 mL of 0.25% bupivacaine before surgical incision. The primary outcome was total tramadol consumption during the first 24 postoperative hours. Secondary outcomes included intraoperative remifentanil consumption, Numeric Rating Scale (NRS) pain scores, Quality of Recovery-15 Turkish Version (QoR-15T) scores, postoperative nausea and vomiting (PONV), and hemodynamic parameters. Sixty patients (30 per group) were analyzed. Compared with controls, the ESPB group demonstrated significantly lower postoperative tramadol consumption (0 [0–40] vs. 40 [0–60] mg; p = 0.030) and intraoperative remifentanil requirements (115 [50–222.5] vs. 200 [100–530] µg; p = 0.008). NRS pain scores were significantly lower in the ESPB group during the first 6 postoperative hours (all p < 0.05), with no differences at 12 and 24 h. QoR-15T scores were significantly higher in the ESPB group (109.5 [95–122.75] vs. 88.5 [79.25–103.75]; p = 0.002). The incidence of PONV and hemodynamic parameters were comparable between groups. Ultrasound-guided ESPB reduced perioperative opioid requirements, improved early postoperative analgesia, and enhanced quality of recovery after PCNL, supporting its use as a component of multimodal analgesia. ClinicalTrials.gov, NCT07457983. Prospectively registered on 04 March 2026.