Objective To investigate the effects of ultrasound‑guided erector spinae plane block (ESPB) on analgesic outcome and rehabilitation after retroperitoneoscopic surgery. Methods A total of 62 patients who were scheduled for retroperitoneoscopic surgery with ultrasound‑guided ESPB in urology were enrolled. They were divided into two groups according to the random number table method (n=31): an erector spinae plane block group (group E) and a control group (group F). Patients in both groups underwent ultrasound‑guided ESPB at the T9 level before general anesthesia. Furthermore, group E received 30 ml of a mixture solution of 0.375% ropivacaine and 0.5 μg/kg dexmedetomidine, while group F was given 30 ml of 0.9% sodium chloride injection. Both groups received general anesthesia by tracheal intubation and entered into post‑anesthesia care unit (PACU) after operation. Patient‑controlled intravenous analgesia (PCIA) was performed in both groups after surgery. Both groups were compared for heart rate and mean arterial pressure (MAP) before anesthesia (I1), at the time of skin incision (I2), at the time of kidney separation (I3), and at the end of surgery (I4). Moreover, the dosages of remifentanil during surgery, sufentanil in PACU and sufentanil in PCIA within 24 h after surgery were recorded. Their Visual Analogue Scale (VAS) score and Bruggrmann Comfort Scale (BCS) score were recorded 3, 6, 9, 12 h and 24 h after surgery. The time of PCIA effective compression (D1) and actual compression (D2) within 24 h after surgery were recorded to calculate D1/D2. Postoperative rehabilitation indicators, including hospitalization stay, the anal exhaust recovery time, the time of drainage tube removal, the time of urinary catheter extubation, and the first time to get out of bed, as well as adverse reactions such as nausea, vomiting and puncture injury were recorded. Results Comparing with group F, group E presented decreases in MAP and heart rate at I2 and I3 (P<0.05). The dosages of remifentanil during surgery, sufentanil in PACU and sufentanil in PCIA 24 h after surgery in group E significantly decreased (P<0.05), with increases in D1/D2, compared with those in group F (P<0.05). Compared with group F, group E presented remarkable decreases in VAS score 3, 6, 9, 12 h and 24 h after surgery, and increases in BCS score (P<0.05). Furthermore, decreases were found in hospitalization stay, the anal exhaust recovery time, the time of drainage tube removal, the time of urinary catheter extubation, and the first time to get out of bed in group E, compared with those in group F (P<0.05). There was no statistical difference in the incidences of postoperative nausea and vomiting between the two groups (P>0.05). No puncture injury was reported in both groups. Conclusions Ultrasound‑guided ESPB is safe and effective in retroperitoneoscopic surgery in urology. It can enhance the postoperative analgesic effects and speed up patient recovery, which is consistent with the concept of accelerated rehabilitation surgery.