Impact of Erector Spinae Plane Block on Postoperative Analgesia and Perioperative Stress Response in Sleeve Gastrectomy: A Prospective Randomized Clinical Trial

TL;DR

This study shows that using erector spinae plane blocks during sleeve gastrectomy reduces postoperative pain, opioid use, and stress response, while improving patient and surgeon satisfaction.

Contribution

The study provides new evidence on the benefits of erector spinae plane blocks in bariatric surgery for pain and stress reduction.

Findings

ESPB significantly reduced postoperative pain scores and opioid consumption in patients undergoing sleeve gastrectomy.

Patients receiving ESPB showed lower cortisol increases, indicating reduced surgical stress response.

ESPB improved patient and surgeon satisfaction without increasing complications.

Abstract

Background and Objectives: Effective postoperative analgesia is essential for enhanced recovery after bariatric surgery. The erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique, but its impact on postoperative pain control, opioid requirement, patient and surgeon satisfaction, and stress response in obese patients undergoing sleeve gastrectomy remains unclear. This study aimed to evaluate the effects of bilateral ESPB on postoperative analgesia requirements, pain scores, patient and surgeon satisfaction, hemodynamic stability, postoperative stress response, and perioperative hematologic and biochemical parameters in ASA II–III patients with a body mass index (BMI) > 30 undergoing sleeve gastrectomy. Study design was a prospective, randomized, single-blind clinical trial. Materials and Methods: After obtaining ethics committee approval (Şanlıurfa Harran University Hospital, date: 23 January 2023; decision no: HRÜ/23.02.09) and written/verbal informed consent, 60 patients aged 18–65 years, BMI > 30, ASA II–III scheduled for elective sleeve gastrectomy were included. Patients were randomized into two groups: those receiving bilateral ESPB (Group E, n = 30) and those without ESPB (Group C, n = 30). Demographic characteristics, ASA scores, comorbidities, and surgical duration were recorded. Preoperative venous samples were collected into hemogram (WBC, lymphocyte, neutrophil) and biochemistry tubes (CRP, cortisol, glucose). Standard monitoring (ECG, SpO2, NIBP) was applied intraoperatively, and vital parameters (HR, MAP) were recorded throughout. Postoperatively, HR, MAP, Numerical Rating Scale (NRS) scores at 0, 2, 4, 8, and 24 h, opioid requirement, patient and surgeon satisfaction (Likert scale), postoperative hemogram and biochemistry values, and side effects or complications were documented. All patients received dexketoprofen as baseline analgesia, with tramadol HCl administered as rescue analgesic. Results: All 60 patients completed the study. There were no statistically significant differences between the groups regarding age, BMI, or surgery duration. Comorbidities were similar between groups. Intraoperative and postoperative HR and MAP values showed no significant differences. Postoperative NRS scores at the 0, 2, 8, and 24 hours were significantly lower in Group E compared with Group C. Both patient and surgeon satisfaction scores were higher in Group E. Rescue analgesic (tramadol HCl) consumption in the postoperative ward was significantly reduced in Group E. Cortisol levels, particularly at the 24th postoperative hour, showed a significantly smaller increase in Group E, suggesting a reduced surgical stress response. No significant differences were found between the groups regarding postoperative side effects or complications. Conclusions: Preoperative bilateral ESPB is an effective component of multimodal analgesia in sleeve gastrectomy. The block significantly reduces postoperative pain intensity, lowers NRS scores, improves patient and surgeon satisfaction, and decreases opioid requirements. Additionally, ESPB appears to attenuate the postoperative stress response, as reflected by smaller increases in cortisol levels. These findings support the routine incorporation of ESPB in perioperative pain management strategies for gastric sleeve surgery.

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