Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 13 1625 1625 Fikri Putro Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Andi Salahudin Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Alamsyah Ala Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Syarifuddin Gaus Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Andi Muh Musba Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. Charles Tan Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. 2026 04 29 2026 05 10 Background: Laparoscopic cholecystectomy (LC) triggers hemodynamic instability and systemic inflammation through sympatho-adrenal activation. The erector spinae plane block (ESPB) is a promising analgesic adjunct, yet its effect on surgical inflammatory response remains inadequately studied. This trial compared bilateral ESPB plus general anesthesia versus general anesthesia only on hemodynamics, postoperative pain, and serum interleukin-6 (IL-6) in elective LC. Methods: Seventy-two adults undergoing elective LC were randomized equally to a control group (general anesthesia only, n = 36) or an ESPB group (bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine per side before induction, n = 36). Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline and every 15 minutes intraoperatively through extubation. Pain was scored by the Numeric Rating Scale (NRS) at 2, 6, and 24 hours postoperatively. Serum IL-6 was measured preoperatively, post-extubation, and at 6 and 24 hours. Results: Baseline characteristics were comparable (p > 0.05). The ESPB Group had significantly lower MAP and HR at all intraoperative time points and extubation (p < 0.05). NRS scores were significantly lower at 2, 6, and 24 hours (p < 0.05). IL-6 was significantly attenuated at all postoperative time points, with the greatest difference at 6 hours (median 63.28 vs. 70.65 pg/mL; p = 0.001). No adverse events were recorded. Conclusion: Bilateral ESPB combined with general anesthesia improves intraoperative hemodynamic stability, sustains analgesia for 24 hours, and attenuates systemic inflammation versus general anesthesia only in elective LC, supporting its incorporation into multimodal anesthetic protocols. https://aacc.tums.ac.ir/index.php/aacc/article/view/1625