Objective: To evaluate the clinical effect and application value of the ultrasound-guided erector spinae plane block (ESPB) in percutaneous nephrolithotomy. Methods: Seventy patients scheduled for percutaneous nephrolithotomy are randomly assigned into two groups (n=35): group E underwent ultrasound-guided T10 level ESPB and received intravenous anesthesia with tracheal intubation, group C received intravenous anesthesia with endotracheal tube. The total dosage of remifentanil during operation and the length of operation were recorded. VAS scores at rest and during activity were also recorded postoperative 2, 6, 12, 18, 24, 48 h. The number of acute analgesia needs and the occurrence of postoperative adverse effect. Results: The difference of dosage of remifentanil during operation and postoperative 6, 12 h VAS scores (rest and activity) in the two groups was statistically significant (P<0.05), Compared with group C, the number of acute analgesia needs and incidence of nausea ware lower in group E. Conclusion: Ultrasound-guided ESPB can significantly reduce the dosage of opioids during operation, effectively improve postoperative pain and reduce the incidence of postoperative adverse reactions in percutaneous nephrolithotomy. It has good clinical application value.