Ultrasound-Guided Techniques for Postoperative Analgesia in Patients Undergoing Laparoscopic Sleeve Gastrectomy: Erector Spinae Plane Block vs. Quadratus Lumborum Block

• Published in: Pain physician 2023-05, Vol.26 (3), p.245-256
• Main Authors: Ashoor, Tarek M, Jalal, Ahmed S, Said, Alfred Maurice, Ali, Mohamed M, Esmat, Ibrahim M
• Format: Article
• Language: English
• Subjects: Analgesia - methods; Analgesics; Analgesics, Opioid - therapeutic use; Anesthesia; Gastrectomy - adverse effects; Gastrointestinal surgery; Humans; Ketorolac; Laparoscopy; Laparoscopy - adverse effects; Nalbuphine; Nerve Block - methods; Obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Prospective Studies; Ultrasonic imaging; Ultrasonography, Interventional - methods
• ISSN: 1533-3159; 2150-1149
• DOI: 10.36076/ppj.2023.26.245

Laparoscopic sleeve gastrectomy (LSG) is a common bariatric surgery. Regional anesthetic techniques decrease postoperative pain, narcotic analgesic requirements, and opioid-related adverse effects in patients scheduled for bariatric surgery. The research team conducted this clinical trial to assess the effects of bilateral ultrasound (US)-guided erector spinae plane block (ESPB) on postoperative pain scores and postoperative analgesics consumption compared with bilateral US-guided quadratus lumborum block (QLB) in the first 24 hours following LSG. A randomized, double-blind, prospective, single-center study. Ain-Shams University Hospitals. Patients: One hundred twenty morbidly obese patients were scheduled for LSG. Were randomly assigned to 3 groups (40 each): bilateral US-guided ESPB, bilateral US-guided QLB, or control (C) group. The time to first rescue analgesia (ketorolac) was considered as a primary outcome. The time to perform the block, the duration of anesthesia, the time to first ambulation, the visual analog scale (VAS) at rest, VAS at movement, the total nalbuphine consumption (mg), the total requirements of rescue analgesia (ketorolac) over the first 24 hours after surgery and the study safety profile were considered as secondary outcomes. The time to perform the block and the duration of anesthesia were higher in the QLB group compared to other groups, with significant differences between ESPB and C groups (P < 0.001, P < 0.001, respectively). The ESPB and QLB groups were superior to the C group as regards the time to first rescue analgesia, the total dose of rescue analgesia, and the total nalbuphine consumption (P < 0.001, P < 0.001, P < 0.001, respectively). In the C group, VAS-R and VAS-M readings were higher in the first 18 hours after surgery (P < 0.001, P < 0.001, respectively). In the rest 6 hours of 24 hours after surgery, the QLB group had lower VAS-R and VAS-M readings than the C group (P < 0.001, P < 0.001, respectively). More patients in the C group had higher incidences of nausea and vomiting (P = 0.011, P = 0.002, respectively). In the C group, the time to first ambulation, the length of PACU stay, and the hospital stay were higher in comparison to the ESPB and QLB groups (P < 0.001, P < 0.001, P < 0.001, respectively). More patients in the ESPB and QLB groups were satisfied with postoperative pain management protocol (P < 0.001). The lack of postoperative respiratory assessment (e.g., spirometry) precluded the identification o