The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

Background: The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG).

Methods: The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention.

Results: Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO₂, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications.

Conclusions: US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.