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
- 1Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Cairo University Cairo Egypt
- 2Department of Anesthesia Technology, College of Applied Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia
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: In this single-center randomized controlled trial, 60 adults aged 18 - 60 years with American Society of Anesthesiologists physical status III and a Body Mass Index (BMI) > 50 kg/m2 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.
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BibTeX
@article{eissa2026efficacy,
title = {{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}},
author = {Amany A Eissa and Mostafa Essam Abdelrahman Abdelmohsen and Marwa Zayed and Nashwa Nabil Mohamed Talaat and Mai Ahmed Ali and Yasmin Hassabelnaby and Fatma Elzahraa Mohamed Haggag and Mona Hamed Elsherbiny},
journal = {Anesthesiology and pain medicine},
year = {2026},
month = jun,
doi = {10.5812/aapm-170030},
url = {https://europepmc.org/article/PMC/PMC13727967},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Amany A Eissa
AU - Mostafa Essam Abdelrahman Abdelmohsen
AU - Marwa Zayed
AU - Nashwa Nabil Mohamed Talaat
AU - Mai Ahmed Ali
AU - Yasmin Hassabelnaby
AU - Fatma Elzahraa Mohamed Haggag
AU - Mona Hamed Elsherbiny
PY - 2026
DA - 2026/06/30
JO - Anesthesiology and pain medicine
DO - 10.5812/aapm-170030
UR - https://europepmc.org/article/PMC/PMC13727967
AB - 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: In this single-center randomized controlled trial, 60 adults aged 18 - 60 years with American Society of Anesthesiologists physical status III and a Body Mass Index (BMI) > 50 kg/m2 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.
SN - 2228-7523
SN - 2228-7531
ER -