Author: John J. Finneran, et al.
Anesthesiology. July 15, 2026.
Continuous erector spinae plane block infusions did not improve pain control or reduce opioid use after percutaneous nephrolithotomy when added to a single-injection erector spinae plane block. These findings suggest that the additional catheter, infusion pump, medication, time, and expense may not be justified for this procedure.
Study Design
This randomized, triple-masked, placebo-controlled clinical trial included 50 adults undergoing outpatient percutaneous nephrolithotomy.
Before surgery, every patient received:
- An ultrasound-guided erector spinae plane catheter at the eighth transverse process
- A single injection of 20 mL of 0.25% bupivacaine with epinephrine
After surgery, patients were randomly assigned to receive an automatic 21-mL bolus every four hours for approximately 57 hours containing either:
- 0.25% bupivacaine
- Normal saline placebo
The two primary outcomes were average pain intensity and cumulative oxycodone consumption during the first two postoperative days.
Key Findings
Average daily pain scores during the first two postoperative days were:
- Continuous bupivacaine: 3.5
- Placebo: 3.0
This difference was not statistically significant.
Cumulative oxycodone consumption was:
- Continuous bupivacaine: 10 mg
- Placebo: 15 mg
There was no statistically significant reduction in opioid consumption with the continuous local anesthetic infusion.
Maximum daily pain scores were also similar:
- Continuous bupivacaine: 7.0
- Placebo: 6.5
The continuous block provided no meaningful improvement in sleep disturbance or pain-related interference with physical and emotional functioning.
Clinical Implications
A single-injection erector spinae plane block may provide most of the analgesic benefit associated with this technique after percutaneous nephrolithotomy.
Continuing local anesthetic through a perineural catheter for more than two days did not provide additional clinically meaningful pain relief or opioid reduction.
The findings suggest that analgesia previously attributed to continuous erector spinae plane infusions may actually represent the residual effects of the initial single-injection block.
Avoiding the continuous catheter could reduce:
- Procedure time
- Local anesthetic exposure
- Infusion-pump requirements
- Catheter-related risks
- Patient inconvenience
- Overall cost
Limitations
The trial included only 50 patients and may not have detected small treatment effects. All patients received an initial single-injection block, so the study did not compare continuous erector spinae plane analgesia with no regional anesthesia.
The findings apply specifically to patients undergoing percutaneous nephrolithotomy and should not automatically be generalized to other surgical procedures.
Conclusion
Adding a continuous erector spinae plane block to a single-injection block did not reduce postoperative pain or opioid consumption after percutaneous nephrolithotomy.
For this procedure, routine placement of a continuous erector spinae plane catheter does not appear to provide sufficient benefit to justify its additional time, complexity, and cost.
We thank Anesthesiology for allowing us to summarize this important clinical research.