The Role of Erector Spinae Block in Urological Surgeries as a Promising Alternative to Conventional Analgesia: A Prospective Observational Study.

Abstract

Introduction: The erector spinae plane block (ESPB) is a regional anesthesia technique that provides somatic and visceral analgesia by targeting the dorsal and ventral rami of the spinal nerves. It is performed under ultrasound guidance. ESPB is particularly beneficial in urological surgeries, which often require multimodal analgesia due to complex pain management needs and patient comorbidities. However, its efficacy in urological procedures remains insufficiently studied. Therefore, our aim was to assess the effectiveness and advantages of ESPB in urological procedures. Material and Methods: This prospective observational study was conducted at a tertiary referral hospital. The study included all consecutive patients scheduled for urological surgery, classical approach, or laparoscopic surgery under general anesthesia. Patients were ASA I-III, aged ≥18 years. Exclusion criteria included coagulopathy, infection at the injection site, allergy to local anesthetics, and chronic opioid therapy. ESPB was performed under ultrasound guidance, and a 20G echogenic needle was used to administer 20-30 mL of 0.5% bupivacaine at the Th8-L2 vertebrae level, depending on surgical requirements. The primary outcome, postoperative pain, was measured using a visual analog scale at 2, 6, 12, and 24 hours. The incidence of postoperative nausea and vomiting (PONV), the total amount of opioids consumed in a 24-hour period, and intraoperative hemodynamic stability were the secondary outcomes. IV fentanyl and paracetamol were used for postoperative analgesia, and metoclopramide was used to control nausea. Results: Fifty patients (42 males, 8 females, mean age 66±9.8 years) were analyzed. The majority were ASA II (44%) and ASA III (50%). Open surgeries were performed on 21 patients, while 19 underwent laparoscopic procedures. Primary Outcome: Pain scores (VAS) at 6h, 12h, and 24h were significantly lower in laparoscopic groups compared to open surgeries (p<0.05). Secondary Outcomes: Only three patients (6%) from the open classical approach surgery required rescue opioids. PONV occurred in two patients (4%): one from the open and the other from the laparoscopic approach surgery. Intraoperative hemodynamics remained stable, with no significant fluctuations in MAP or HR. Conclusion: ESPB provided effective analgesia, reduced opioid consumption, and maintained hemodynamic stability in urological surgeries, supporting its role in multimodal pain management strategies.