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Perioperative Truncal Peripheral Nerve Blocks for Bariatric Surgery: An Opioid Reduction Strategy

Published:January 20, 2023DOI:https://doi.org/10.1016/j.soard.2023.01.014
Perioperative Truncal Peripheral Nerve Blocks for Bariatric Surgery: An Opioid Reduction Strategy
Previous ArticleBariatric Surgery in Patients with Obesity and End-Stage Renal Disease
Next ArticleImplications regarding concurrent hiatal repair during Sleeve Gastrectomy should be carefully evaluated

      Abstract

      Background

      Bariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit.

      Objectives

      Study the effect of PNB on postoperative pain and opioid use following bariatric surgery

      Settings

      Academic medical center, USA

      Methods

      We conducted a cohort study of patients who underwent Sleeve Gastrectomy (SG) or Roux-en-Y Gastric Bypass (RYGB) surgery. 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores

      Results

      PVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared to the ERAS protocol cohort at 24 hours (93.9 mg vs 42.8 mg), P-value: <0.0001; at 48 hours (72.6 mg vs 40.5 mg); and in pain scores at 24 hours (5.64/10 vs 4.46/10), P-value: 0.02. OME and pain scores were higher in the SG cohort.

      Conclusions

      Addition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption.
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      Article info

      Publication history

      Accepted: January 14, 2023
      Received in revised form: November 14, 2022
      Received: September 12, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosure Statement:

      None of the authors have conflicts of interest or financial disclosures or ties regarding this study

      Highlights

      1. Perioperative Truncal Peripheral Nerve Blocks in patients underwent Sleeve Gastrectomy or Roux-en-Y Gastric Bypass resulted in a 54% reduction in oral morphine equivalents (OMEs) requirements perioperatively and up to 24 hours postoperatively

      2. Intraoperative and PACU OME requirements showed a 73% reduction in the block group versus the control group

      3. There was a 67% reduction in OME requirements in the paravertebral block (PVT) group compared to the transversus Abdominis plane (TAP) group

      Identification

      DOI: https://doi.org/10.1016/j.soard.2023.01.014

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.

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