Nerve Block Before Kidney Stone Surgery Cuts Opioid Needs and Speeds Recovery

Patients undergoing percutaneous nephrolithotomy, a minimally invasive procedure to remove kidney stones, often still experience significant postoperative pain. A randomized controlled trial now reports that an ultrasound-guided erector spinae plane block reduced opioid consumption during surgery and in the first day after the operation, eased early pain, and improved patients’ self-rated quality of recovery. The findings, published in BMC Urology, support the block as one component of multimodal analgesia for this procedure.

The study was a prospective, randomized, assessor-blinded, controlled trial in patients scheduled for elective percutaneous nephrolithotomy under general anesthesia. Sixty patients were analyzed, thirty per group, assigned to receive either the block or standard care as a control. In the intervention group, a unilateral ultrasound-guided block was performed at the tenth thoracic vertebral level, injecting 20 milliliters of 0.25% bupivacaine before the surgical incision.

The primary outcome was total tramadol consumption during the first 24 hours after surgery. Patients who received the block used significantly less tramadol than controls, with a median of 0 milligrams compared with 40 milligrams in the control group, a difference significant at p = 0.030. The block also reduced intraoperative remifentanil requirements, with median use of 115 micrograms in the block group versus 200 micrograms in controls, significant at p = 0.008.

Pain intensity was assessed using the Numeric Rating Scale. Scores were significantly lower in the block group during the first 6 postoperative hours, with all comparisons in that window reaching p < 0.05. However, the analgesic advantage did not persist: at 12 and 24 hours, pain scores were comparable between the groups.

Quality of recovery was measured using the Quality of Recovery-15 Turkish Version, a patient-reported instrument. Scores were significantly higher in the block group, with a median of 109.5 compared with 88.5 in controls, significant at p = 0.002. This suggests that reduced pain and lower opioid exposure translated into a subjectively better early recovery experience.

Not all outcomes favored the block. The incidence of postoperative nausea and vomiting was comparable between the groups, as were hemodynamic parameters. The absence of a difference in nausea and vomiting despite lower opioid consumption is a notable observation, and the stable hemodynamic parameters indicate the block did not produce clinically meaningful cardiovascular changes in either direction.

The trial was prospectively registered on ClinicalTrials.gov under identifier NCT07457983 on 04 March 2026. The article was published on 04 November 2026 as an open-access paper, and the version shared at publication is a peer-reviewed, accepted manuscript carrying a permanent DOI, subject to further edits before the final Version of Record replaces it.

Several limitations shape how these results should be interpreted. The sample was small, with sixty patients analyzed, and the outcomes come from a single trial without external replication. The block was performed unilaterally at a single thoracic level with a fixed dose of bupivacaine, so the optimal side, level, volume, and concentration for different patients remain open questions. Pain scores converged by 12 hours, meaning the analgesic benefit is concentrated in the early postoperative period. The study did not report longer-term outcomes such as chronic pain or return to normal activities.

Within those boundaries, the trial provides controlled evidence that a single preincisional erector spinae plane block can lower intraoperative remifentanil requirements, reduce postoperative tramadol consumption, improve early pain control, and enhance patient-reported quality of recovery after percutaneous nephrolithotomy. The authors position the technique as a component of multimodal analgesia, meaning it would complement rather than replace other pain-control measures. For a procedure in which postoperative pain remains a clinical challenge despite its minimally invasive nature, the results offer an evidence-based option that anesthesiology and urology teams can weigh when planning perioperative pain management.

Subject of Research: Perioperative effects of ultrasound-guided erector spinae plane block in patients undergoing percutaneous nephrolithotomy

Article Title: Perioperative efficacy of erector spinae plane block in patients undergoing percutaneous nephrolithotomy

Article References: Tosun, F., Karbaş, U., Sulhan, H., Yılmaz, N., & Bozkurt, Z. (2026). Perioperative efficacy of erector spinae plane block in patients undergoing percutaneous nephrolithotomy. BMC Urology. https://doi.org/10.1186/s12894-026-02458-x

Image Credits: AI Generated

DOI: 10.1186/s12894-026-02458-x

Keywords: erector spinae plane block, percutaneous nephrolithotomy, regional anesthesia, postoperative pain, opioid consumption, tramadol, remifentanil, quality of recovery, multimodal analgesia, randomized controlled trial, ultrasound-guided block, BMC Urology