Background <p>Postoperative pain remains inadequately managed despite advances in anaesthetic techniques, leading to delayed recovery, increased opioid use, and postoperative complications. Although laparoscopic abdominal surgeries are minimally invasive, pneumoperitoneum and tissue traction contribute to significant postoperative pain. The erector spinae plane (ESP) block, introduced in 2016, has emerged as an effective regional analgesic technique providing extensive somatic and visceral analgesia with minimal adverse effects. Compared with conventional systemic analgesia, ESP block offers opioid-sparing benefits, improved patient comfort, and earlier mobilization. While its efficacy has been demonstrated in various abdominal procedures, direct comparisons with parenteral analgesia, particularly in the Indian population remain limited. This study evaluates the effectiveness of ESP block versus conventional systemic analgesia for postoperative pain control following laparoscopic abdominal surgery.</p> Methods <p>A prospective randomized controlled study was conducted in the Department of General Surgery at Sagar Hospital, Tilak Nagar, Bangalore from June 2023 to April 2025. Patients undergoing elective laparoscopic abdominal surgeries under general anaesthesia were randomized into two groups. Group A consisted of patients who received ESP block preoperatively and paracetamol postoperatively. Group B included those who received only paracetamol postoperatively. Pain assessment was performed using the Visual Analogue Scale (VAS) at 2, 4, 6, 12, 24, and 48-hours following surgery. The requirement for further analgesics, occurrence of postoperative nausea and vomiting, and any complications were recorded and analysed. </p> Results <p>A total of 140 patients undergoing laparoscopic abdominal surgery were analysed. Patients in the ESP block group were significantly younger than those in the non-ESP group (41.7 ± 15.9 vs. 52.1 ± 15.6 years; <i>p</i> = 0.0002), while sex distribution was comparable (<i>p</i> = 0.395). Postoperative pain scores were significantly lower in the ESP group at all time points from 2 to 48 h, with marked differences during the early postoperative period (2–12 h; <i>p</i> &lt; 0.001) and sustained significance at 24 h (<i>p</i> &lt; 0.001) and 48 h (<i>p</i> = 0.006). Rescue analgesic requirements were significantly reduced in the ESP group, particularly at 2 h and 12 h postoperatively (<i>p</i> &lt; 0.001), with no patient in either group requiring additional analgesia beyond 24 h. No postoperative complications were observed in either group. Postoperative nausea and vomiting and length of hospital stay were comparable between groups, with no statistically significant differences (<i>p</i> &gt; 0.05).</p> Conclusion <p>Ultrasound-guided erector spinae plane block offers effective postoperative analgesia with reduced opioid requirements following laparoscopic abdominal surgery and represents a safe, simple, and valuable component of multimodal pain management.</p>