417: Comparison of Erector Spinae Plane Block/Epidural Block for Postoperative Analgesia in Nephrectomies

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Pharmacological treatments, Pain in Special Populations , Treatment/management

Background and Aims: Nephrectomy, whether via open or laparoscopic approach, represents a crucial surgical intervention [1]. Unfortunately, acute postoperative pain following nephrectomy remains a formidable challenge, with approximately 20–26% of patients experiencing chronic pain, often leading to increased opioid consumption and associated adverse effects [2]. This unresolved pain can significantly impact various body systems, including endocrine, circulatory, immunological, neurological, and musculoskeletal [3]. Despite the advantages of laparoscopic nephrectomy, such as quicker recovery and reduced pain compared to open surgery, a subset of patients still experiences postoperative discomfort. In this study, we compared the analgesic efficacy of ultrasound guided continuous Erector Spinae plane block (ESPB) GroupI with Epidural block (EB) Group II in the subset of patients undergoing laparoscopic nephrectomy.
Primary objective: Time of use of first dose of rescue analgesia.
Secondary objective: Cumulative dose of rescue analgesics consumed in 24 hours postoperatively.
Post-operative VAS
Procedure related complications.

Methods: • Patients of either sex aged 18 to 65years.
• ASA physical status I, II and III scheduled for laparoscopic nephrectomy under GA.
A review preanesthetic checkup was done one-night before surgery..
Patients were randomly assigned into two groups of 30 each –
Group I:Patients receiving ultrasound-guided continuous ESPB
Group II: Patients receiving Epidural Block using landmark technique
Upon entering the operating room, standard ASA monitors were connected, and baseline vitals were noted. Ultrasound-guided ESPB (unilateral side) was performed in the lateral position and Epidural block was placed in the sitting position before the induction of general anesthesia. Both groups adhered to a standardized anaesthesia protocol.
The following parameters were recorded: immediately and at regular intervals after the surgery.
 Time of first dose of rescue analgesia and total dose of rescue analgesia.
 Total intraoperatively fentanyl consumption
 Pain score (VAS)
 Hemodynamics
 Ambulation/Bowel recovery
 Complications

Results: In this study, we compared the analgesic efficacy of ultrasound guided continuous Erector Spinae plane block (ESPB) Group I with Epidural block (EB) Group II in the subset of patients undergoing laparoscopic nephrectomy who had similar demographic variables.
• We found that time of first dose of rescue analgesia, total dose of rescue analgesia, postoperative VAS score and total intraoperative fentanyl consumption were comparable in both groups. Therefore, both Erector Spinae Plane Block and Epidural Block are equally effective in the management of post-nephrectomy pain.
• Postoperative hemodynamic variables, time for ambulation and bowel recovery were also comparable in both the groups.
• Erector Spinae Plane Block has an advantage over Epidural Block as it is a unilateral block so there are less chances of hypotension. Since ESPB is an interfascial plane block, it has a better safety profile as compared to epidural block in deranged coagulation profile patients.

Conclusions: We conclude that, in the presence of expertise, continuous ESPB can be a better and suitable alternative to epidural block with same efficacy for postoperative analgesia in laparoscopic nephrectomy patients. To the best of our understanding, this is the first study to compare the analgesic efficacy of a continuous ESPB with an epidural block in patients scheduled for laparoscopic nephrectomy. The above findings could potentially impact the improvement of recovery post-surgery in urology through ERAS protocols.

References: 1. Acar C, Bilen C, Bayazit Y, et al. Quality of life survey following laparoscopic and open radical nephrectomy. Urology Journal. 2014;11(06):1944-50.
2. Owen M, Lorgelly P, Serpell M. Chronic pain following donor nephrectomy – A study of the incidence, nature and impact of chronic post-nephrectomy pain. European Journal of Pain. 2010;14(7): 732-734.
3. Greenberg EN. The consequences of chronic pain. Journal of Pain & Palliative Care Pharmacotherapy. 2012;26(1):64-7.

Presenting Author: Monica Kohli
Submitting Author: Monica Kohli

Senior Author: Monica Kohli

IASP 2026 Global Year theme of Neuropathic Pain: No

• Amita Singh: MD - King George's Medical University