Nephrectomy (kidney removal) is one of the most common surgical procedures in urologic
practice. Recent advances in laparoscopic (keyhole) procedures have resulted in a significant
decrease in open nephrectomies. Most laparoscopic surgeries are performed through 3 to 4
small (1 to 1.5 cm) incisionsÍž however, laparoscopic nephrectomies for cancer include one of
the incisions being extended to 7 to 10 cm for kidney removal. Although pain after
laparoscopic surgery is somewhat less than that after open surgery, it is still significant,
and opioid consumption is similar. Opioids have been a mainstay for the treatment of
post-operative pain, but they are associated with many adverse effects and a potential for
long-term use. Thus, combining opioid analgesia with other forms of analgesia has the
potential to reduce opioid use. Paravertebral nerve blocks, where local anesthetic is
injected near the spinal nerves, have recently shown good pain control in patients undergoing
thoracic and abdominal surgeries. However, this technique is technically challenging, time
consuming, and has the risk of significant side effects. Fascial plane blocks are an
alternative to paravertebral blocks. Fascial plane blocks, where local anesthetic is injected
in areas further away from the spinal nerves, are easier to perform than paravertebral
blocks, and have fewer associated risks. A recently described fascial plane block, the
Erector Spinae Plane (ESP) block, has been shown to be effective in controlling pain in a
variety of surgeries. However, currently, there is little information regarding its use in
laparoscopic nephrectomy. We are proposing this pilot randomized control trial to look at the
feasibility of completing a larger randomized control trial to evaluate ESP blockade in
patients undergoing laparoscopic nephrectomy for cancer. We will also investigate total
opioid consumption, and pain scores at rest and during movement.