ESP Block vs. EXORA Block for Postoperative Pain in Nephrectomy

NCT07640282 | Recruiting

• 1 other identifier: BEAH 2026/191
• Study Type: observational
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this observational study is to learn about the effects of two pain control techniques used after laparoscopic nephrectomy (kidney removal surgery) in adults. The study will compare Erector Spinae Plane (ESP) block and External Oblique Rectus Abdominis (EXORA) block, which are both used as part of routine medical care to help control pain after surgery. The main questions it aims to answer are: Do ESP block and EXORA block differ in how well they control pain after surgery? Do ESP block and EXORA block differ in their effects on recovery quality and the need for additional pain medication? Researchers will compare participants who receive ESP block with participants who receive EXORA block as part of routine clinical care. Participants will: Undergo laparoscopic nephrectomy according to routine clinical practice. Receive either ESP block or EXORA block based on the treating anesthesiologist's usual clinical preference. Complete a recovery questionnaire before surgery and 24 hours after surgery. Have pain scores, use of additional pain medication, nausea and vomiting, and other routine postoperative measurements recorded during the first 24 hours after surgery.

Conditions

Postoperative Pain; Nephrectomy

Keywords

Erector Spinae Plane Block; EXORA Block; Laparoscopic Nephrectomy; Postoperative Analgesia; Quality of Recovery

Outcome Measures

Primary Outcomes (1)

• Postoperative Pain Score (NRS)

  Postoperative pain will be assessed using the Numeric Rating Scale (NRS, 0-10). Pain scores will be recorded at 1, 6, 12, and 24 hours after surgery and will be compared between Group E and Group X. The Numeric Rating Scale ranges from 0 to 10 (0 = no pain, 10 = worst imaginable pain); higher scores indicate worse pain.

  Postoperative 1, 6, 12, and 24 hours

Secondary Outcomes (2)

• Rescue Analgesic Requirement

  First 24 hours after surgery

• Quality of Recovery (QoR-15 Score)

  Preoperative baseline and postoperative 24th hour

Other Outcomes (1)

• Postoperative Nausea and Vomiting (PONV) Score

  Postoperative 1, 6, 12, and 24 hours

Study Arms (2)

Group E

Participants undergoing laparoscopic nephrectomy who receive Erector Spinae Plane (ESP) block as part of routine clinical care.

Procedure: Erector Spinae Plane Block

Group X

Participants undergoing laparoscopic nephrectomy who receive External Oblique Rectus Abdominis (EXORA) block as part of routine clinical care.

Procedure: External Oblique Rectus Abdominis Block

Interventions

Erector Spinae Plane Block PROCEDURE

An ultrasound-guided Erector Spinae Plane (ESP) block is performed under general anesthesia prior to extubation as part of routine clinical practice. After aseptic preparation, a linear ultrasound probe is placed over the T10 transverse process on the surgical side. The needle is advanced into the fascial plane between the erector spinae muscle and the transverse process. Following negative aspiration and confirmation of correct needle placement with hydrodissection, 30 mL of 0.25% bupivacaine is injected. The procedure is performed by anesthesiologists according to routine clinical practice without researcher involvement in clinical decision-making.

Also known as: ESP BLock

Group E

External Oblique Rectus Abdominis Block PROCEDURE

An ultrasound-guided External Oblique Rectus Abdominis (EXORA) block is performed under general anesthesia prior to extubation as part of routine clinical practice. After aseptic preparation, a linear ultrasound probe is positioned in the parasternal sagittal plane lateral to the xiphoid process at the level of the 8th costal cartilage on the surgical side. The needle is advanced into the fascial plane between the rectus abdominis and external oblique muscles. Following negative aspiration and confirmation of correct needle placement with hydrodissection, 30 mL of 0.25% bupivacaine is injected. The procedure is performed by anesthesiologists according to routine clinical practice without researcher involvement in clinical decision-making.

Also known as: EXORA Block

Group X

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult patients aged 18-80 years undergoing laparoscopic nephrectomy and receiving either an Erector Spinae Plane (ESP) block or an External Oblique Rectus Abdominis (EXORA) block according to routine clinical practice.

You may qualify if:

• Age between 18 and 80 years
• Patients scheduled for laparoscopic nephrectomy
• Patients for whom Erector Spinae Plane (ESP) block or External Oblique Rectus Abdominis (EXORA) block has been selected by the treating clinician
• ASA physical status I-III

You may not qualify if:

• No regional block performed in routine clinical practice
• Body mass index (BMI) greater than 35 kg/m²
• History of opioid dependence
• Alcohol or other substance dependence
• Psychiatric disease, mental retardation, dementia, or any condition impairing pain perception or pain assessment

Sponsors & Collaborators

• Bakirkoy Dr. Sadi Konuk Research and Training Hospital: lead

Study Sites (1)

Bakirkoy Dr. Sadi Konuk Research and Training Hospital

Istanbul, Istanbul, 34147, Turkey (Türkiye)

RECRUITING

Related Publications (5)

• Okmen K, Demirel A, Dogan AK, Ertus CY. Application of EXORA block for analgesia following hand-assisted laparoscopic donor nephrectomy (HALDN). Indian J Anaesth. 2025 Mar;69(3):324-326. doi: 10.4103/ija.ija_1263_24. Epub 2025 Feb 17. No abstract available.

  PMID: 40161911 BACKGROUND

• Chin KJ, El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anaesth. 2021 Mar;68(3):387-408. doi: 10.1007/s12630-020-01875-2. Epub 2021 Jan 6.

  PMID: 33403545 BACKGROUND

• Nalbant B, Donmez A, Altinsoy S, Kavak Akelma F. Efficacy of OSTAP, ESP block, trocar site local anesthetic injection in elective laparoscopic cholecystectomy: A randomized controlled trial. Medicine (Baltimore). 2025 Aug 1;104(31):e43607. doi: 10.1097/MD.0000000000043607.

  PMID: 40760576 BACKGROUND

• Yang M, Cao L, Lu T, Xiao C, Wu Z, Jiang X, Wang W, Li H. Ultrasound-guided erector spinae plane block for perioperative analgesia in patients undergoing laparoscopic nephrectomies surgery: a randomized controlled trial. Trials. 2024 Jan 2;25(1):10. doi: 10.1186/s13063-023-07866-0.

  PMID: 38167138 BACKGROUND

• Amir S, Siddiqui AH, Haris M, Laique F, Amini B, Mehboob M, Mohiuddin M, Azam MM, Mukhtar S, Akram Z, Zainab B, Rizwan S, Moeed A, Surani S. Ultrasound-guided erector spinae plane block for perioperative analgesia in laparoscopic nephrectomy: A systematic review and meta-analysis. World J Nephrol. 2025 Dec 25;14(4):110268. doi: 10.5527/wjn.v14.i4.110268.

  PMID: 41479827 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

Şeyma Nur Güner Zengin, MD

CONTACT

+90 212 414 71 71; snurguner@gmail.com

Nalan Saygı Emir, MD, Associate Professor

CONTACT

+90 212 414 71 71; nasaemir@hotmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical Doctor

Study Record Dates

• First Submitted: June 4, 2026
• First Posted: June 10, 2026
• Study Start: June 1, 2026
• Primary Completion (Estimated): August 1, 2029
• Study Completion (Estimated): August 1, 2029
• Last Updated: June 10, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)