Paragastric Neural Blockade Effectively Controls Visceral Pain After Primary Laparoscopic Sleeve Gastrectomy

Area of Science:

• Anesthesiology
• Surgical Pain Management
• Gastrointestinal Surgery

Background:

• Enhanced Recovery After Surgery (ERAS) protocols improve perioperative care but visceral pain (VP) remains challenging.
• Standard multimodal analgesia (MMA) often inadequately controls early postoperative VP.
• Paragastric neural blockade (PGNB) is explored as a targeted intervention for VP.

Purpose of the Study:

• To evaluate the effectiveness of PGNB in managing early postoperative visceral pain following laparoscopic sleeve gastrectomy (LSG).
• To compare pain intensity and analgesic requirements between patients receiving standard MMA and those receiving PGNB plus MMA.
• To assess secondary outcomes including time to analgesia, analgesic consumption, and incidence of nausea/vomiting.

Main Methods:

• A retrospective study compared 50 patients receiving standard MMA (including TAP block) with 50 patients receiving PGNB plus MMA.
• The primary outcome was pain intensity measured by Numeric Rating Scale (NRS) within 48 hours post-surgery.
• Secondary outcomes included time to first analgesic, cumulative analgesic doses, nausea/vomiting, and hemodynamics.

Main Results:

• PGNB group showed significantly lower NRS scores within 8 hours postoperatively (p<0.001).
• Time to first rescue analgesic was prolonged (1084 min vs 260 min; p<0.001) and analgesic use was reduced in the PGNB group.
• Operative time was longer in the PGNB group (113.9 min vs 97.8 min; p<0.001); one localized hematoma occurred with no other complications.

Conclusions:

• PGNB effectively reduces visceral pain and the need for rescue analgesics in the early postoperative period after LSG.
• The technique is associated with prolonged time to first analgesic and reduced overall analgesic consumption.
• PGNB demonstrates a favorable safety profile with no major complications observed.