TRANSFORMING POST-OPEN NEPHRECTOMY PAIN CONTROL: THE ROLE OF THE ERECTOR SPINAE PLANE BLOCK IN PROVIDING ANALGESIA DURING PERIOPERATIVE PERIOD. A RANDOMIZED CONTROLLED TRIAL
ESPB In Open Nephrectomy
Abstract
Objective: To determine whether ultrasound-guided erector spinae plane block (ESPB), added to standardised general anaesthesia and multimodal analgesia, reduces 24-hour opioid consumption and postoperative pain compared with systemic analgesia alone after open nephrectomy.
Methods: This prospective, assessor-blinded randomized controlled trial was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from 30th May 26 to August 12th 26. Ninety-two adults (18–60 years, ASA I–III) undergoing elective open nephrectomy for benign disease were randomised 1:1 to ultrasound-guided ESPB (25 mL of 0.25% bupivacaine) after induction or no block, on an identical general anaesthetic and multimodal analgesic background (nalbuphine, paracetamol, ketorolac). Rescue nalbuphine was given for a numeric pain rating scale (NPRS) score >3. Co-primary outcomes were 24-hour nalbuphine consumption and NPRS from PACU arrival to 24 hours; secondary outcomes included time to first rescue, nausea, vomiting, sedation and complications. Analysis was by intention-to-treat.
Results: All 92 patients were analysed (46 per group). Median 24-hour nalbuphine was 12.0 mg (IQR 10.0–14.0) with ESPB versus 25.0 mg (20.5–28.0) in controls (Hodges–Lehmann difference −12.0 mg, 95% CI −14.0 to −10.0; p<0.001). Median time to first rescue was 10.7 h versus 1.3 h (p<0.001). NPRS was lower with ESPB from PACU arrival to 6 h (all p<0.001) but not at 12 h (p=0.208) or 24 h (p=0.159). ESPB reduced nausea (37.0% vs 65.2%), vomiting (4.3% vs 23.9%) and sedation (28.3% vs 73.9%) (all p≤0.007). Block success was 91.3%; no block-related complications occurred.
Conclusion: ESPB provided clinically meaningful opioid-sparing analgesia, prolonged the analgesia-free interval by about nine hours, and reduced opioid-related adverse effects after open nephrectomy without complications. The advantage was concentrated in the first 6 hours, supporting its use within multimodal analgesia and prompting evaluation of strategies to extend its duration.
Keywords
- Erector spinae plane block; Nephrectomy; Postoperative pain; Opioid-sparing analgesia; Regional anaesthesia; Nalbuphine; Randomized controlled trial
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