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Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy; a randomized controlled trial.

BACKGROUND
Pain control in the morbidly obese has presented as an anesthetic challenge. The aim of this study is to assess the analgesic efficacy of ultrasound guided bilateral erector spinae block compared to bilateral subcostal transversus abdominis plane block.


METHODS
Prospective randomized, double-blinded controlled study was conducted at Kasr Alainy Hospital on 66 patients scheduled for laparoscopic sleeve gastrectomy. Patients were randomly allocated into three groups and received general anesthesia: bilateral erector spinae block at the level of T9 or bilateral subcostal transversus abdominis block or opioid analgesia (control group). The primary outcome was pain assessment by of Visual Analogue Scale.


RESULTS
Visual Analogue Scale were lower in the Erector spinae and Transversus abdominis groups compared with the control group throughout the first 12 postoperative hours (p=<0.001). Visual analogue score was lower in Erector spinae group in relation to control group at 18th postoperative hour (P=0.034). Visual analogue scores in the Erector spinae group were significantly lower compared to Transversus abdominis at the 12 postoperative hours. 24hours postoperative pethidine consumption was higher in the control group (median 150 and IQR 100-200) compared to both erector spinae (median 0 and IQR 0-50) and transversus abdominis (median 50 and IQR 0-100) groups (p-value <0.001). Erector spinae group showed less pethidine consumption than transversus abdominis group.


CONCLUSIONS
Ultrasound-guided single-shot T9 erector spinae plane block lowers postoperative pain scores, and reduces intraoperative and postoperative opioid consumption compared with both the subcostal approach transversus abdominis plane block and the control group in obese patients that had undergone sleeve gastrectomy.