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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.22169    [Epub ahead of print]
Published online May 18, 2022.
The Feasibility and Efficacy of erector spinae plane block versus Transversus Abdominis Plane Block In Laparoscopic Bariatric Surgery : A Randomized Comparative Trial
Mohamed Elshazly, Yasser Mohamed EL-Halafawy, Dina Zakaria Mohamed, Khaled Abd El Wahab, Tamer Mohamed Kheir Mohamed
Department of anesthesia, surgical ICU, and pain management, faculty of medicine, Cairo University, Cairo, Egypt
Corresponding author:  Mohamed Elshazly, Tel: 201016109777, 
Email: dr.mohamed.elshazly8686@gmail.com
Received: 17 March 2022   • Revised: 15 May 2022   • Accepted: 16 May 2022
Abstract
Background
Overweight and obesity present a rising public health problem. Bariatric surgeries are one modality of weight reduction. Pain after surgery can increase the length of hospital stay, with all the associated consequences especially in such vulnerable population. Regional anesthesia can offer a modality of pain control, yet the feasibility of performing abdominal wall block is questionable in patients suffering from obesity.
Methods
Sixty adult patients with BMI of 40–50 kg/m2 undergoing laparoscopic bariatric surgery were randomly assigned to receive either ultrasound guided transversus abdominis plane (TAP) or erector spinae plane (ESP) block. The primary outcome was the analgesic effect as assessed by mean visual analogue scale (VAS) score in the first 24 hours postoperative. Secondary outcomes were time taken to perform a successful block, the incidence of complications related to each block, the time for first rescue analgesia in each block, the time to first flatus or stool motion, and total opioid consumption.
Results
The mean VAS score during the first 24 hours postoperatively was higher in TAP group compared to ESP group (2.78±0.34 vs 2.32±0.12, p <0.0001), time to first rescue analgesia was prolonged in ESP group (p value = 0.001), time to perform successful block was higher in TAP group (p=0.001). However, the incidence of complications, and total opioid consumption, and other secondary outcomes are similar between the groups.
Conclusions
Compared with TAP block, bilateral ESP block is a more feasible and an effective method for intra and postoperative analgesia for patients undergoing laparoscopic bariatric surgery.
Key Words: Bariatric surgery, Analgesia, Nerve block, Acute pain services, Anesthesia, Opioids
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