Work

The Efficacy of Ultrasound-Guided Thoracic Erector Spinae Plane Block for Perioperative Analgesia During Laparoscopic Bariatric Surgery in Super-Obese Patients: A Randomized Controlled Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Background: Super-obese patients undergoing laparoscopic bariatric surgery are at an increased risk of opioid-related respiratory compromise, underscoring the need for opioid-sparing analgesia. Objectives: To compare bilateral ultrasound-guided thoracic erector spinae plane block (ESPB) and trocar-site local anesthetic infiltration with respect to perioperative opioid consumption and early postoperative pain. Methods: who were scheduled for laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized 1:1 to receive bilateral T7 ESPB with 0.25% bupivacaine (30 mL/side) or trocar-site infiltration with 0.5% bupivacaine (5 mL/site). The primary outcome was cumulative perioperative opioid consumption during the first 24 hours, expressed as an intravenous morphine-equivalent dose. Secondary outcomes included intraoperative fentanyl use, Visual Analog Scale pain scores at rest and during coughing, time to first rescue analgesia, time to ambulation, hemodynamics, the 15-item Quality of Recovery (15-item Quality of Recovery questionnaire (QoR-15)) score at 24 hours, and complications. Results: ESPB reduced intraoperative fentanyl requirements (56.7% vs 100%; total dose, 50 [25 - 75] vs 100 [100 - 212.5] µg; both P < 0.001) and cumulative 24-hour morphine-equivalent consumption (11 [9.75 - 13] vs 24.5 [22 - 33], mg; P < 0.001). Visual analog scale scores were lower with ESPB at rest at 4 and 8 hours and during coughing within the first 8 hours (all P < 0.001). Erector spinae plane block prolonged the time to first rescue analgesia (8 [8 - 12] vs 4 [4 - 8], h) and enabled earlier ambulation (4.07 ± 0.78 vs 4.60 ± 0.67 h; both P < 0.001). The QoR-15 score was higher with ESPB (118.8 ± 5.35 vs 106.6 ± 3.91; P < 0.001). Conclusions: In super-obese patients, thoracic ESPB provided a clinically meaningful opioid-sparing effect, improved early pain control and quality of recovery, and facilitated earlier mobilization following laparoscopic bariatric surgery.

Source: Anesthesiology and Pain Medicine

DOI: 10.5812/aapm-170030