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The following is a summary of “Reducing pain and opioid use: Implementation of an enhanced recovery pathway for percutaneous nephrolithotomy with an erector spinae plane block,” published in the March 2025 issue of Current Urology by Saxton et al. 

Researchers conducted a prospective study on an Enhanced Recovery After Surgery (ERAS) pathway with a preoperative erector spinae plane (ESP) block for percutaneous nephrolithotomy, which improved pain control and reduced opioid use postoperatively. 

They created an ERAS pathway for percutaneous nephrolithotomy with a preoperative ESP block and multimodal analgesia. Patient charts were retrospectively reviewed and divided into two cohorts: ERAS pathway and traditional pain control. Postoperative morphine equivalents were the primary outcome, while secondary outcomes included nursing pain scores, opioid prescriptions for home, and quality of life. Mann-Whitney U and χ² tests were used for continuous and categorical variables, respectively. 

The results showed 60 patients with ERAS and 70 in the traditional cohort. Postoperative morphine equivalents were lower (17.0 vs 39.9, P < 0.01), and nursing pain scores decreased (2.4 vs 3.6, P < 0.01). Fewer patients with ERAS needed opioid prescriptions for home (53% vs 80%, P < 0.01). Quality of life was similar, and no adverse events occurred. 

Investigators found that an ERAS pathway with a preoperative ESP block and multimodal analgesia reduced morphine equivalents and nursing pain scores. Future randomized prospective studies with the ERAS protocol were considered. 

Source: journals.lww.com/cur/fulltext/9900/reducing_pain_and_opioid_use__implementation_of_an.194.aspx