Comparison of the effects of erector spinae plane and transversus abdominis plane blocks on postoperative pain in obesity surgery ESP vs TAP for Postoperative Pain in Bariatric Surgery

Abstract Backgroundː Obesity is a major global health concern, and bariatric surgery is a widely used treatment. Postoperative pain management in these patients is challenging due to comorbidities limiting opioid use. Regional anesthesia techniques such as the transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are key components of multimodal analgesia. The TAP block targets the abdominal wall but may offer limited visceral pain relief. The ESP block, a newer method, allows for broader analgesia and may be easier to administer in obese patients. This study compared the postoperative analgesic efficacy and feasibility of TAP and ESP blocks in laparoscopic bariatric surgery. Methodsː In this retrospective review, 64 adult patients (ASA III, BMI 40–60 kg/m²) who underwent elective laparoscopic sleeve gastrectomy received either a TAP block (n=30) or an ESP block (n=34). Data on demographics, pain scores (VAS), time to first analgesic requirement, patient satisfaction, and adverse events were collected. The primary outcome was the mean VAS score within 24 hours postoperatively. Resultsː Baseline characteristics were similar. Both techniques were safe and well tolerated. The ESP group had significantly lower VAS scores at the 2nd postoperative hour (p=0.028), but differences diminished thereafter. Patient satisfaction was high in both groups (96.9%). Conclusionsː TAP and ESP blocks both provided effective, opioid-sparing analgesia with minimal complications. The ESP block may offer procedural advantages in obese patients. The choice between techniques can be guided by patient-specific factors and practitioner expertise. Further prospective studies are needed to explore long-term outcomes.