Comparative study between ultrasound guided erector spinae block versus thoracic paravertebral block versus quadratus lamborum block for postoperative analgesia after open renal surgeries: a prospective randomized controlled study.

BACKGROUND: Open renal surgeries are associated with significant postoperative pain, which may delay recovery and increase opioid requirements. Ultrasound-guided regional anesthesia techniques such as erector spinae plane block (ESPB), thoracic paravertebral block (PVB), and quadratus lumborum block (QLB) have emerged as effective components of multimodal analgesia. OBJECTIVE: To compare the analgesic efficacy of ESPB, PVB, and QLB versus systemic analgesia in patients undergoing elective open renal surgeries. METHODS: This prospective, randomized, controlled study included 48 patients (ASA I-II) undergoing open renal surgery. Patients were allocated into four groups (n = 12 each): ESPB, PVB, QLB (each received 20 ml of 0.25% bupivacaine), and control (IV morphine). Postoperative pain was assessed using the visual analogue scale (VAS) at 2, 4, 6, 12, 18, and 24 hours. Total 24-hour morphine consumption and patient satisfaction were recorded. RESULTS: VAS scores were significantly lower in all block groups compared to the control group at all-time points (p < 0.001), with no significant differences among ESPB, PVB, and QLB. Total morphine consumption was highest in the control group (25.0 ± 4.5 mg), followed by ESPB (12.0 ± 3.2 mg), PVB (10.0 ± 2.8 mg), and QLB (8.0 ± 2.5 mg) (p < 0.001). Patient satisfaction was significantly higher in the block groups, particularly in the QLB group. CONCLUSIONS: ESPB, PVB, and QLB provide effective postoperative analgesia and reduce opioid consumption after open renal surgeries. QLB demonstrated the most favorable opioid-sparing effect, although all techniques showed comparable analgesic efficacy.