Association of adjunctive paragastric autonomic neural blockade added to multimodal analgesia with postoperative pain and quality of recovery following laparoscopic sleeve gastrectomy: a retrospective comparative analysis

This study aims to comparatively evaluate the association between paragastric autonomic neural blockade (PG-ANB) and postoperative clinical outcomes, primarily pain, in the early postoperative period in patients undergoing laparoscopic sleeve gastrectomy (LSG). In this single-center retrospective observational study, the data of patients who underwent LSG between June 2024 and December 2025 and met the eligibility criteria were analyzed. Patients were divided into two groups: those who received PG-ANB (Group P, n = 37) and those who did not (Group C, n = 41). The primary endpoint was the postoperative 6-hour Visual Analog Scale (VAS) score. Secondary endpoints were postoperative 1-, 12-, and 24-hour VAS scores, the 6-hour postoperative nausea and vomiting (PONV) score, hourly and total opioid consumption, time to first mobilization, length of hospital stay, and preoperative and postoperative 24-hour Quality of Recovery-15 (QoR-15) scores. Multivariable linear regression was used to adjust for operative time, and analysis of covariance was used to adjust for preoperative QoR-15 scores. Postoperative 1-, 6-, 12-, and 24-hour VAS scores and the 6-hour PONV score were significantly lower in Group P ( p < 0.001, p = 0.028, p = 0.010, p = 0.040, and p = 0.043, respectively). Time to first mobilization was shorter in Group P ( p < 0.001). Opioid consumption was lower in Group P only at postoperative 1 h ( p = 0.015), whereas total opioid consumption and the postoperative 24-hour total QoR-15 scores were similar between the groups ( p > 0.05). Operation time was longer in Group P ( p < 0.001). After adjustment for operative time, only the 1-hour VAS score and time to first mobilization remained significantly lower in Group P ( p = 0.007 and p = 0.002, respectively). The addition of PG-ANB to multimodal analgesia after LSG was associated with lower very early postoperative pain scores and earlier mobilization, and these associations persisted after adjustment for operative time. However, the differences in later pain scores, PONV, and the primary 6-hour VAS endpoint did not remain significant after this adjustment. Further multicenter, large-scale, prospective, preferably randomized studies are needed to confirm these findings and to determine whether any benefit justifies the additional operative time.