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The goal of this clinical trial is to determine whether the erector spinae plane (ESP) block provides better pain relief after flexible ureterorenoscopy (URS) surgery compared to standard analgesia alone. Researchers want to know:
Does the ESP block reduce pain levels in the first 24 hours after surgery?
Does it lower the need for opioid pain medication?
Does it reduce the need for additional (rescue) pain treatment?
Does it decrease the likelihood of postoperative nausea and vomiting (PONV)?
Participants will be randomly placed into one of two groups:
ESP Block Group: Participants will receive an ESP block using 20 mL of 0.25% bupivacaine under ultrasound guidance before surgery.
Control Group: Participants will receive standard pain management without a nerve block.
All participants will receive general anesthesia during surgery and multimodal pain management after surgery. Researchers will compare pain scores, opioid use, rescue analgesic needs, and the occurrence of nausea and vomiting between the two groups.
Intervention Group (ESP Block): Patients will receive 20 mL of 0.25% bupivacaine (1:1 diluted with 0.5% bupivacaine) under ultrasound guidance at the T8-T10 level.
Control Group: No block will be performed, and patients will receive standard postoperative multimodal analgesia.
Procedure Description: The ESP block will be performed under sterile conditions with a high-frequency linear ultrasound probe. A 100-mm echogenic needle will be inserted in a cephalocaudal direction to deposit the local anesthetic deep to the erector spinae muscle at the transverse process level. The correct spread of the anesthetic will be confirmed via real-time ultrasound imaging.
All patients will receive standardized general anesthesia and multimodal analgesia.
Outcome measures include postoperative pain (NRS), opioid consumption, rescue analgesia requirement, and postoperative nausea and vomiting (PONV).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ESP Block Group | Experimental | A regional anesthesia technique in which 20 mL of 0.25% bupivacaine is injected under ultrasound guidance at the T8-T10 level to provide postoperative pain relief. |
|
| Control Group | No Intervention | Patients will receive routine multimodal analgesia without an ESP block. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector Spinae Plane (ESP) Block | Procedure | A regional anesthesia technique in which 20 mL of 0.25% bupivacaine is injected under ultrasound guidance at the T8-T10 level to provide postoperative pain relief. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity (Numeric Rating Scale - NRS) | The Numeric Rating Scale (NRS, 0-10) will be used to assess postoperative pain intensity. Participants will be asked to rate their pain on a scale from 0 to 10, where:
| 0, 2, 6, 12, 24 hours postoperatively. |
| Measure | Description | Time Frame |
|---|---|---|
| Total Opioid Consumption (IV PCA Morphine Equivalent) | Description: Total opioid consumption will be recorded in morphine milligram equivalents (MME) administered via IV patient-controlled analgesia (PCA). | From 0 hours (postoperatively) to 24 hours postoperatively, assessed at 0, 2, 6, 12, and 24 hours. |
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Inclusion Criteria:
Patients undergoing elective flexible ureterorenoscopy (URS).
Age: 18-65 years.
ASA I-II.
Willing to participate and provide written informed consent.
Exclusion Criteria:
BMI >35 kg/m².
Allergy to local anesthetics.
Coagulation disorders or use of anticoagulants.
Patients requiring emergency surgery.
Patients with infection at the ESP block site.
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| Name | Affiliation | Role |
|---|---|---|
| Ayhan Åžahin, Assoc. Prof. | Namik Kemal University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tekirdağ Namık Kemal University Research Hospital | Tekirdağ | 59000 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27501016 | Background | Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451. | |
| 33807296 | Background | Bryniarski P, Bialka S, Kepinski M, Szelka-Urbanczyk A, Paradysz A, Misiolek H. Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy. Int J Environ Res Public Health. 2021 Mar 31;18(7):3625. doi: 10.3390/ijerph18073625. |
| Label | URL |
|---|---|
| Ref. 2 | View source |
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| ID | Term |
|---|---|
| D000377 | Agnosia |
| D053040 | Nephrolithiasis |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D010268 | Parapsychology |
| D003766 | Dental Occlusion |
| ID | Term |
|---|---|
| D001525 | Behavioral Sciences |
| D004191 | Behavioral Disciplines and Activities |
| D003813 | Dentistry |
| D009063 | Dental Physiological Phenomena |
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| Postoperative Nausea and Vomiting (PONV) |
The incidence of postoperative nausea and vomiting (PONV) will be recorded, defined as nausea and/or vomiting requiring treatment with ondansetron IV. |
| From 0 hours (postoperatively) to 24 hours postoperatively, assessed at 0, 2, 6, 12, and 24 hours. |
| Pain-Free Duration | Pain-free duration is defined as the time from the end of surgery to the first request for analgesia (when the patient reports pain requiring medication). | From the end of surgery until the first request for pain medication, assessed up to 24 hours postoperatively. |
| 42121081 | Derived | Sahin A, Baran O, Dogan C, Sahin MF, Arar C. Erector spinae plane block for postoperative analgesia in patients undergoing flexible ureteroscopy: a randomized controlled trial. BMC Anesthesiol. 2026 May 13;26(1):401. doi: 10.1186/s12871-026-03884-y. |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052878 | Urolithiasis |
| D052801 | Male Urogenital Diseases |
| D055688 | Digestive System and Oral Physiological Phenomena |