AIM: To evaluate the value of ultrasound-guided erector spinae plane block (ESPB) combined with opioid-sparing anaesthesia in extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. METHODS: A total of 96 patients (60 males and 36 females, aged 20-65 years, ASA I-II, BMI 16-30 kg/m2) undergoing elective extracorporeal shock wave lithotripsy for pancreatic duct stones were selected in our hospital from March 2022 to April 2023. The patients were randomly divided into conventional intravenous anesthesia group (group C, 48 cases) and ESPB+ opioid-sparing group (group E, 48 cases). Patients in group C underwent general anesthesia with target-controlled infusion of propofol and remifentanil with spontaneous breathing. Patients in group E underwent ultrasound-guided bilateral ESPB before intravenous general anesthesia. The changes of hemodynamic indexes (HR, MAP) in the two groups were observed and recorded. The anesthetic effect, dosage of remifentanil, quality of anesthesia recovery, postoperative analgesic effect and incidence of perioperative adverse reactions (respiratory depression, nausea and vomiting, pruritus, etc.) were observed in the two groups. RESULTS: Compared with group C, the incidence of intraoperative respiratory depression was significantly decreased, the intraoperative consumption of remifentanil was decreased, and the postoperative recovery time was shortened in group E (P<0.05). The VAS scores of rest and cough pain and the incidence of postoperative nausea and vomiting were significantly decreased in group E (P<0.05). There was no significant difference in HR and MAP between the two groups (P>0.05). CONCLUSION: Ultrasound-guided ESPB in ESWL for pancreatic duct stones is satisfactory and can save opioids with few complications.