Ultrasound‐Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial.

ULTRASONIC imaging; ANALGESIA; CONFIDENCE intervals; BARIATRIC surgery; BUPIVACAINE; ERECTOR spinae muscles; LAPAROSCOPIC surgery; SURGERY; PATIENTS; VISUAL analog scale; FENTANYL; TREATMENT effectiveness; RANDOMIZED controlled trials; MORPHINE; DESCRIPTIVE statistics; STATISTICAL sampling; LONGITUDINAL method; REHABILITATION

Background: Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound‐guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. Methods: A total of 60 patients aged 18 to 65 years with a body mass index (BMI) of ≥ 40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20 mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24‐hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. Results: Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] μg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] μg) (P < 0.001). The median (IQR) cumulative 24‐hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P < 0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. Conclusion: Ultrasound‐guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group. Bariatric surgery is frequently complicated with considerable postoperative pain. Postoperative analgesia in obese patients is very challenging due to increased susceptibility to respiratory depressant effect of opioids. We evaluated the effect of ultrasound‐guided erector spinae plane block (ESPB) on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. Sixty morbidly obese patients aged 18 to 65 years with a BMI of ≥ 40 were randomly allocated into two groups to receive either bilateral ESPB using 20 ml bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 ml normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24‐hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. Our results showed that ESPB was associated with significantly lower pain scores during the first eight postoperative hours. The intraoperative fentanyl as well as the cumulative 24‐hour postoperative morphine consumption was significantly reduced and the time to first rescue analgesic request was significantly prolonged in the ESPB group. In addition, pulmonary function tests were significantly impaired postoperatively in both groups compared with baseline values with no significant differences between the groups. We concluded that ultrasound‐guided ESPB provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group. [ABSTRACT FROM AUTHOR]

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