Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous...

To compare recovery quality after PCNL using ESPB, TPVB, and placebo.

Randomized, double-blind, placebo-controlled trial.

Sanming First Hospital affiliated to Fujian Medical University in China.

120 adults with American Society of Anesthesiologists physical status I-II scheduled for elective unilateral PCNL.

Patients were randomized 1:1:1 to receive ESPB, TPVB, or placebo to test ESPB superiority over placebo and non-inferiority to TPVB.

The primary outcome was Quality of Recovery-15 (QoR-15) score at 24 h. We tested ESPB superiority over placebo (8-point clinically important difference) and non-inferiority to TPVB (6-point margin). Secondary outcomes included pain scores, morphine consumption, time to first rescue analgesia, patient satisfaction, and adverse events.

ESPB demonstrated significantly higher QoR-15 scores than placebo (median difference 11.0 points, 95% CI 7.0-14.0, P < 0.001) and met non-inferiority criteria versus TPVB (median difference 1.0 point, 95% CI -5.0 to 2.0). Both blocks reduced pain scores and morphine consumption by approximately 40% compared with placebo (P < 0.001), with no differences between techniques. Time to first rescue analgesia was prolonged with both blocks compared with placebo (P < 0.001). Patient satisfaction was higher with both blocks than with placebo (P < 0.001). No block-related complications occurred; postoperative adverse events were similar across groups.

ESPB significantly improved recovery quality after PCNL, demonstrating superiority to placebo and non-inferiority to TPVB. ESPB represents an effective alternative to TPVB for PCNL analgesia, with comparable efficacy and safety.