Erector spinae plane block as an effective alternative for postoperative pain control after open kidney surgery

BACKGROUND: Despite advances in anesthesiology, postoperative pain following open kidney surgery remains a major clinical challenge. High pain intensity in the early postoperative period often leads to increased opioid consumption and a higher risk of complications. Within the ERAS (Enhanced Recovery After Surgery) concept, increasing attention is given to safe regional analgesic techniques that reduce opioid requirements. One such method is the erector spinae plane block (ESP block), whose effectiveness in open urologic surgery is insufficiently studied.

AIM: This study aimed to evaluate the effectiveness of the ESP block as a component of multimodal anesthesia in patients undergoing open kidney surgery during the intraoperative and early postoperative periods.

METHODS: A prospective, controlled study included 116 patients divided into two groups: the main group (n = 60, with ESP block) and the control group (n = 56, without block). Patients older than 18 years with ASA physical status I–III and without contraindications to regional anesthesia were included. Primary outcomes were intraoperative fentanyl consumption, postoperative use of trimeperidine, pain intensity assessed by the numerical rating scale, incidence of nausea and vomiting, need for nonsteroidal anti-inflammatory drugs and paracetamol, and length of stay in the intensive care unit. Statistical analysis was performed using SPSS 25.0; significance level p < 0.05.

RESULTS: ESP block significantly reduced fentanyl consumption: 0.027 ± 0.01 μg/(kg·min) vs. 0.046 ± 0.02 μg/(kg·min) (p < 0.01) and the need for trimeperidine within the first 6 hours (5.0% vs. 55.6%; p < 0.001). Pain intensity on the numerical rating scale was significantly lower in the main group at all observation points (median 0.0 vs. 3.0–7.0; p < 0.001). The incidence of postoperative nausea and vomiting was 10–15 times lower in the main group (p < 0.001), as was the need for nonsteroidal anti-inflammatory drugs and paracetamol. Length of stay in the intensive care unit decreased 3.7-fold (2.88 ± 0.17 h vs. 10.89 ± 3.51 h).

CONCLUSIONS: ESP block in open renal surgery demonstrates high clinical effectiveness as part of multimodal anesthesia, providing marked analgesia, reducing opioid load, and improving postoperative recovery.