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ERECTOR SPINAE PLANE BLOCKS SIGNIFICANTLY REDUCE NARCOTIC USE AFTER PRIMARY BARIATRIC SURGERY
Alhasan A. Alani
*, Cruz Velasco-Gonzalez, William S. Richardson
Ochsner Medical Center, New Orleans, LA
IntroductionThis study evaluates the efficacy of erector spinae plane blocks (ESB) in reducing postoperative opioid consumption in adult patients undergoing bariatric surgery, to aiming to optimize pain management and to minimize opioid-related complications in this population.
MethodsAdult patients undergoing primary sleeve gastrectomy or gastric bypass at a single institution (January 1–June 30, 2024) were identified. Group A received no block, and Group B received bilateral preoperative single-injection ESP blocks with 60 mL of injectate containing (1) 0.375% bupivacaine, epinephrine (1:300,000), dexamethasone (1 mg), and clonidine (50 mg) or (2) 0.375% bupivacaine with epinephrine (1:200,000). Opioid use, recorded as morphine milligram equivalents (MME), was assessed at five intervals: prior to incision (PTI), intraoperative, recovery, postoperative day 0 (POD0), and postoperative day 1 (POD1), and postoperative day 2 (POD2) .
ResultsA total of 82 patients (51 no-block, 31 block) were included. PTI, 2.0% of no-block group were opioid free, compared to 12.9% of block group. Intraoperatively, the proportion of opioid-free patients was comparable for no-block group (64.7%) and block group (71%) p = 0.559, although the patients in block group who received opioids got higher MME (36.0 ± 46.9 vs. 18.7 ± 7.2,
p < 0.001). In the recovery period MME was similar between groups (block: 27.4 ± 16.8 vs. no-block: 27.7 ± 14.0,
p = 0.235), with slightly more opioid-free patients in the block group (6.4% vs. 2.0%) [Fig. 1].
On POD0, the block group had significantly lower MME (10.0 ± 4.0 vs. 12.7 ± 5.5,
p = 0.015), with nearly half of patients opioid-free (48.4% vs. 43.1%,
p = 0.643). On POD1, the block group showed a significantly higher proportion of opioid-free patients (48.4% vs. 22.0%,
p = 0.015), though there was no significant difference in average MME among those receiving opioids [Fig. 1]. On POD2, 13 patients remained hospitalized (3 block, 10 no-block). The block group had higher MME (42.8 ± 22.3 vs. 10.8 ± 5.1) and a lower proportion of opioid-free patients (33.3% vs. 40.0%), although the sample size is too small for statistical analysis [Fig. 1].
ConclusionESB significantly reduced opioid consumption on POD0 and the need for opioids on POD1. However, our results suggest that analgesia from ESB is not as effective by POD2. This supports the role of ESB in reducing opioid use in patients undergoing primary sleeve gastrectomy or gastric bypass.
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