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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Postoperative pain management in spine surgery remains challenging, often relying heavily on opioids. This study evaluated the analgesic efficacy of bilateral ESPB in reducing opioid consumption and improving pain control during major spine surgeries. Primary outcomes included total opioid consumption and NOL values. Secondary outcomes were postoperative pain scores, adverse events, and length of hospital stay.Methods This prospective study included 30 patients undergoing lumbar discectomy, spinal fusion, or laminectomy. Bilateral ESPB was performed preoperatively under ultrasound guidance. Intraoperative nociception was continuously monitored using the Nociception Level (NOL) index, an objective measure derived from physiological signals including heart rate, skin conductance, and photoplethysmography. NOL values between 10–25 were considered normal, with values outside this range for >60 seconds indicating nociceptive stimulation. Analgesia was titrated to maintain NOL within the target range. Postoperative pain was assessed using the Numeric Rating Scale (NRS) or NVPS-R. Primary outcomes included total opioid consumption and NOL values. Secondary outcomes were postoperative pain scores, adverse events, and length of hospital stay.Results ESPB demonstrated effective pain control across all surgery types. Spinal fusion surgeries showed a mean NOL (9.67), compared to laminectomy (10.48) and discectomy (6.70). Mean total intraoperative remifentanil doses were 243.64±129.4 mcg, 180.56±65.47 mcg, and 87.76±55.6 mcg for fusion, laminectomy, and discectomy, respectively. Postoperative morphine consumption averaged 5.43±3.15 mg. Pain scores in the post-anesthesia care unit using VAS decreased from 2.57 on arrival to 0.87 after two hours. Complications were minimal, with urinary retention being the most common (20%).Abstract P182 Figure 1Sonoanatomy of the ESP blockAbstract P182 Table 1Demographics and clinical background summaryAbstract P182 Figure 2NOLConclusions Bilateral ESPB, combined with NOL-guided analgesia, effectively reduced opioid consumption and improved pain control in major spine surgeries. This technique demonstrated a favorable safety profile and ease of application, making it a promising option for perioperative pain management in spine surgery. Further large-scale, randomized controlled trials are warranted to validate these findings.