Epidural anesthesia for laparoscopic bariatric surgery: a case report

Area of Science:

• Anesthesiology
• Bariatric Surgery
• Obesity Medicine

Background:

• General anesthesia presents challenges for morbidly obese patients undergoing bariatric surgery.
• Advances in surgical techniques and reduced pneumoperitoneum times make regional anesthesia a potential option.

Purpose of the Study:

• To evaluate the feasibility and outcomes of epidural anesthesia in morbidly obese patients for laparoscopic bariatric procedures.
• To explore an alternative anesthetic technique for improved postoperative recovery.

Main Methods:

• Case series involving two morbidly obese patients (BMI 39 and 47 kg/m²) undergoing laparoscopic sleeve gastrectomy and gastric bypass.
• Epidural anesthesia administered at T9-T10, with modified surgical techniques (low-flow CO2, no orogastric tube).
• Spontaneous breathing maintained throughout the procedure, with management of intraoperative hypotension and shoulder pain.

Main Results:

• Both patients maintained spontaneous respiration without difficulty.
• Successful management of hypotension and shoulder pain.
• Postoperative analgesia provided with epidural morphine; both patients were discharged uneventfully.
• Potential benefits include preserved respiratory function, increased alertness, and reduced need for rescue analgesics.

Conclusions:

• Epidural anesthesia can be a viable alternative to general anesthesia for selected morbidly obese patients undergoing laparoscopic bariatric surgery.
• Further prospective studies are needed to confirm advantages and disadvantages.