Abstract Background Obesity is a global health issue, with laparoscopic sleeve gastrectomy (LSG) recognized as an effective surgical option for sustained weight loss. However, postoperative pain management, particularly for visceral pain (VP), remains a challenge. The transversus abdominis plane (TAP) block, primarily target somatic pain and often fall short in controlling VP, leading to nausea, vomiting, and longer hospital stays. The paragastric neural block (PGNB) has been introduced to enhance pain management by targeting autonomic nerves involved in gastric tone, complementing the TAP block to provide better coverage of VP and improve postoperative recovery after LSG. Methods Patients were randomly assigned in a double-blind manner to two groups: one received only TAP, and the other received both PGNB and TAP after LSG. The primary outcome was patient-reported pain measured with an 11-point visual analogue scale. Secondary outcomes included analgesic use, antiemetic requirements, operation time, time to mobilization, nausea, vomiting, hiccups, tachycardia, hypertension, and complications (for example, bleeding, infection). Changes in mean arterial pressure and heart rate were also recorded 10 minutes post-blockade. Results Of the 127 patients, those who received both PGNB and TAP blocks (n = 64) experienced significantly lower postoperative pain scores at 4, 8, and 12 hours compared to those who received TAP block alone. By the 24th hour, the difference in VAS scores was no longer statistically significant (P = 0.65). At 4 hours postoperatively, the combined block group had a notably lower median VAS score (2 IQR 2–3) compared to the TAP-only group (3 IQR 3–5; P 0.001). Analgesic use was reduced (P 0.001), and the incidence of nausea and vomiting was lower, with fewer patients requiring supplementary antiemetics (P = 0.04). Patients receiving both blocks also mobilized earlier (190 ± 53 versus 240 ± 49 minutes, P = 0.01). There was no significant difference in operation time (PGNB + TAP: 64 ± 15 minutes versus TAP-only: 56 ± 12 minutes, P = 0.45). Conclusion The study demonstrates that combining the paragastric neural block with the TAP block significantly enhances pain management in patients undergoing sleeve gastrectomy, leading to earlier mobilization without affecting operation time compared to the TAP-only group.
Abokhozima et al. (Thu,) studied this question.