Erector spinae plane block for sleeve gastrectomy - Trial PACTR202103492888628

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Summary

Pain following bariatric surgery is troublesome, and despite the laparoscopic approach, up to 42% of patients undergoing laparoscopic Bariatric surgery experience severe pain. Somatic pain from the laparoscopic port sites can be treated with local anesthetic infiltration; however, visceral epigastric pain can be more difficult to manage. The use of opioids is limited by concerns regarding patient somnolence at emergence, as well as postoperative respiratory depression, particularly given the high prevalence of obstructive sleep apnea in this population, opioid-related adverse effects like paralytic ileus, nausea, and vomiting. NSAIDs are often avoided due to reported associations with gastrointestinal anastomotic leaks 5 and the development of marginal ulcers, although the risk from a single dose is unclear. Regional anesthesia techniques offer good pain relief, reduce perioperative opioid and anesthetic use, reduces postoperative nausea/vomiting, helps in reducing chronic pain, and facilitates early rehabilitation.Subcostal transversus abdominis plane blocks have not been shown to offer any additional benefit over systemic multimodal analgesia in this patient population, possibly because of the fact that TAP blocks provide only somatic analgesia. The erector spinae plane block is a newly defined regional anesthesia technique for thoracic analgesia. Its use for other indications, such as abdominal and thoracic surgery, has also recently been reported. In this technique, the local anesthetic injection is performed beneath the erector spinae muscle. Local anesthetic expected to achieve paravertebral spread of three vertebral levels cranially and four levels caudally. While a similar analgesic effect might be obtained with a thoracic epidural or bilateral paravertebral blocks, the ESP block offers significant advantages in terms of ease of performance and safety. The transverse processes of the thoracic vertebrae and the erector spinae muscles are easily identified even

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