Laparoscopic Sleeve Gastrectomy
Conditions
Brief summary
Obesity poses severe global health risks and induces complex cardiorespiratory alterations, making perioperative care critical. For patients with morbid obesity, Laparoscopic Sleeve Gastrectomy (LSG) is the most effective long-term treatment. However, despite being minimally invasive, LSG causes significant early postoperative pain from trocar insertion, pneumo-peritoneum, and visceral trauma. Uncontrolled pain can lead to impaired respiratory function, delayed recovery, and increased opioid-related side effects. Enhanced Recovery After Surgery (ERAS) protocols emphasize opioid-sparing multimodal analgesia. While local port-site infiltration is inexpensive and simple, its effects are localized and short-lived, often requiring supplemental opioids. In contrast, the ultrasound-guided External Oblique Intercostal (EOI) block targets the fascial plane between the external oblique and intercostal muscles (T6-T10). It provides superficial, easily identifiable landmarks in obese patients and delivers widespread sensory blockade across the upper anterior abdominal wall. To evaluate superior pain management strategies, a prospective, randomized, controlled study compares the analgesic efficacy of ultrasound-guided bilateral EOI block versus conventional port-site local anesthetic infiltration in patients undergoing elective LSG. Key Study Metrics (First 24 Postoperative Hours) Primary Outcomes: Total postoperative opioid consumption and pain scores. Secondary Outcomes: Time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), overall patient satisfaction, and recovery metrics. Ultimately, demonstrating the superior efficacy of the EOI block over port-site infiltration may refine perioperative analgesic protocols, reduce opioid dependence, and improve recovery outcomes in bariatric surgery.
Interventions
patients undergoing laparoscopic sleeve gastrectomy receiving port-site infiltration with 5 ml 0.25% bupivacaine at each port site.
PROCEDUREExternal Oblique Intercostal Block
ultrasound-guided external oblique intercostal block with 30 ml 0.25% bupivacaine bilaterally.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* • Age 18-65 years * BMI between 35 kg/m2 and 40 kg/m² * ASA (I-II-III) * Elective laparoscopic sleeve gastrectomy * Ability to provide informed consent
Exclusion criteria
* • Patient refusal * Allergy to local anesthetics * Coagulopathy * Infection at injection site * Chronic opioid use * Hepatic failure * Renal failure * Conversion to open surgery * OSAS-home CPAP * Cardiac patients * Super morbid \>50 kg / m²
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption | 24 hours | Total opioid consumption (IV NALUFIN) during the first 24 postoperative hours |
Outcome results
None listed