The erector spinae plane (ESP) block is an effective alternative for managing pain after open kidney surgery.

Background. Despite advances in anesthesiology, postoperative pain following open kidney surgery remains a significant clinical challenge, necessitating the implementation of safe and effective components of multimodal analgesia that align with current ERAS protocols, while minimizing opioid use and associated side effects.

Objective.To evaluate the effectiveness of the ESP block as a component of multimodal anesthesia in patients undergoing open kidney surgery during the intraoperative and early postoperative periods.

Methods. A prospective study was conducted involving 116 patients divided into two groups: the ESP block group (n=60) and the control group (n=56). Inclusion criteria: age over 18 years, ASA physical status I–III, no contraindications to regional anesthesia. Primary endpoints included intraoperative fentanyl consumption, postoperative use of promedol, pain scores using the Numerical Rating Scale (NRS), incidence of postoperative nausea and vomiting (PONV), use of NSAIDs and paracetamol, and ICU length of stay. Statistical analysis was performed using SPSS 25.0; p-values < 0.05 were considered significant.

Results.ESP block significantly reduced fentanyl consumption (0.027±0.01 μg/kg/min vs. 0.046±0.02; p<0.01) and the need for promedol during the first 6 hours postoperatively (5.0% vs. 55.6%; p<0.001). Pain scores were significantly lower in the ESP group at all time points (median 0.0 vs. 3.0–7.0; p<0.001). The incidence of PONV was 10–15 times lower (p<0.001), as was the need for NSAIDs and paracetamol. ICU stay was significantly shorter in the ESP group (2.88 ± 0.17 h vs. 10.89 ± 3.51 h).

Conclusion.The ESP block in open kidney surgery demonstrated high clinical effectiveness as part of multimodal analgesia, providing superior pain control, reduced opioid consumption, fewer adverse effects, and enhanced postoperative recovery.