Efficacy of the erector spinae plane block in laparoscopic sleeve gastrectomy: a pilot, single-center, prospective, randomized clinical study

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Abstract

BACKGROUND: Effective postoperative pain control in bariatric surgery remains a challenging clinical task, especially in patients with morbid obesity. The erector spinae plane block (ESP block) is a promising regional anesthesia technique that may reduce opioid consumption and improve recovery.

AIM: This study aimed to evaluate the analgesic efficacy of the ESP block compared with standard analgesia in patients undergoing laparoscopic sleeve gastrectomy.

METHODS: A pilot, single-center, prospective, randomized, placebo-controlled study included 20 patients who underwent laparoscopic sleeve gastrectomy: the ESP group (n = 10; 20 mL of 0.5% ropivacaine on each side at the T7 level) and the control group (n = 10; 0.9% NaCl administered using the same technique, sham block). Pain was assessed using the visual analog scale (at rest/during movement) at 2, 4, 6, 12, and 24 hours. Intraoperative hemodynamic parameters, opioid consumption, incidence of postoperative nausea and vomiting, and time to mobilization were recorded.

RESULTS: Patients in the ESP block group had significantly lower visual analog scale pain scores at all time points compared with the control group (p < 0.01). Intraoperative fentanyl consumption and postoperative tramadol consumption were significantly lower in the ESP group (p < 0.01). More stable hemodynamics were observed in the ESP group during the 30–120 minutes after induction, as well as a lower incidence of postoperative nausea and vomiting (10% vs. 80%). Time to first mobilization was significantly shorter in the ESP group (mean 7.1 h vs. 12.3 h, p < 0.01).

CONCLUSIONS: The ESP block provides effective analgesia, reduces opioid requirements, improves hemodynamic stability, and facilitates early rehabilitation in patients after laparoscopic sleeve gastrectomy. The technique may be used as part of multimodal analgesia and ERAS protocols in bariatric surgery.

About the authors

Marat R. Akhmadullin

City Clinical Oncology Dispensary, Saint Petersburg; MEDSI

Author for correspondence.
Email: akhmadullin.marat.rad@yandex.ru
ORCID iD: 0009-0004-6753-5066
SPIN-code: 4175-4096
Russian Federation, Saint Petersburg; Saint Petersburg

Nadezhda G. Marova

MEDSI; North-Western State Medical University named after I.I. Mechnikov

Email: mnsno@mail.ru
ORCID iD: 0000-0002-5801-9594
SPIN-code: 5935-5615

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Yaroslav I. Vasiliev

City Clinical Oncology Dispensary, Saint Petersburg; North-Western State Medical University named after I.I. Mechnikov

Email: yaroslav.Vasilev@szgmu.ru
ORCID iD: 0000-0001-9758-2390
SPIN-code: 4425-9169

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Victor A. Koriachkin

Saint-Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

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