الفهرس 
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
Abstract
Obesity has been associated with an increased hazard ratio for all-cause mortality, as well as significant medical and psychological co-morbidity. Laparoscopic sleeve gastrectomy Procedure indicated for patients with clinically severe obesity. The goal of postoperative pain management is provision of comfort, early mobilization, and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization.
ESPB is a promising regional anesthetic and a relatively safe procedure for analgesia in both acute postoperative pain as well as neuropathic pain. The use of QLB block has been awash in many laparoscopic and open abdominal surgeries suggesting that the QLB is an effective option for postoperative analgesia. Through extension of local anesthetic agent to the thoracic paravertebral space, the wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution.
The aim of this study was to assess the analgesic efficacy of ultrasound guided ESPB compared with ultrasound guided QLB after laparoscopic sleeve gastrectomy surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions.
After approval of anesthesia department scientific and ethical committees in Ain Shams University Hospitals, 120 morbidly obese patients were included in the study, and were divided into three groups (n=40; each); group ESPB group QLB, and group C.
All patients received general anesthesia. After surgical port closure and before extubation;
Patients of the ESPB group: received bilateral injection of (0.3 ml/kg LBW) of bupivacaine 0.25% under the erector spinae muscle, and bilateral US-guided sham block at the QLB site.
Patients of the QLB group received bilateral injection of (0.3 ml/kg LBW) of bupivacaine 0.25% at the posterior border of the quadratus lumborum muscle. and bilateral US-guided sham block at the ESPB site.
Patients of the Control (C) group received bilateral US guided sham block at both sites of ESPB and QLB.
Every sham block injection was performed under US-guidance to demonstrate the possible injection site of the corresponding block and in the form of a 2 mL subcutaneous injection of normal saline solution.
The three groups were adequately monitored and assessed intra-operatively and postoperatively. They were compared regarding analgesic outcome by using the visual analogue scaling system, and recording the time needed for the first call of rescue analgesia and its total consumption in the first 24 postoperative hours, demographic data, intra-operative and postoperative hemodynamics.
The results of this study revealed that bilateral ultrasound-guided erector spinae plane block and bilateral ultrasound-guided quadratus lumborum block provided adequate postoperative pain control and reduced postoperative analgesic requirements for morbidly obese patients scheduled for laparoscopic sleeve gastrectomy with priority to bilateral erector spinae plane block. Being an easy technique to perform with low rate of complications.