Modified External Oblique Intercostal Plane Block Versus Erector Spinae Plane Block for Open Nephrectomy

This prospective, randomized, assessor-blinded clinical trial aims to compare the postoperative analgesic efficacy of ultrasound-guided Erector Spinae Plane Block (ESPB) and Modified External Oblique Intercostal Plane Block (EOIPB) in patients undergoing elective open nephrectomy under general anesthesia. Sixty adult patients will be randomized to receive either ESPB or EOIPB before surgical incision. All participants will receive standardized general anesthesia and postoperative multimodal analgesia. Postoperative pain scores, opioid consumption, rescue analgesic requirements, and postoperative nausea and vomiting will be assessed during the first 24 hours after surgery. The study aims to determine whether one fascial plane block technique provides superior postoperative pain control and recovery following open nephrectomy.

Inclusion Criteria: * Age between 18 and 65 years. * American Society of Anesthesiologists (ASA) physical status I or II. * Scheduled for elective open nephrectomy. * Able and willing to provide written informed consent. * Willing to comply with study procedures. Exclusion Criteria: * Refusal to participate or inability to provide informed consent. * Emergency surgery. * Body mass index (BMI) greater than 35 kg/m². * Known allergy or hypersensitivity to local anesthetics. * Infection at the planned block insertion site. * Coagulopathy or ongoing anticoagulant therapy. * Pregnancy or breastfeeding. * Prisoners or other vulnerable populations unable to provide independent consent.