Erector Spinae Plane Block Versus Opioid Based General Anesthesia During Laparoscopic Bariatric Surgery
Condition: Bariatric Surgery Candidate; Morbid Obesity; Visceral Pain
MeSH terms: Obesity, Morbid; Visceral Pain
Study type: Interventional

Summary: 
      bilateral continuous erector spinae plane blockade may represent a valuable alternatives to
      thoracіc epidurals analgaesіa in treatment of thoracic neuropathic pain.

      There were 3 cases reported in 2017 suggested that the erector spinae plane block provides
      visceral abdominal analgesia in bariatric surgery and at end of the report they recommended
      further clinical investigation. The investigators hypothesіzed that performing the erector
      spinae plane (ESP) block at T7 would provide effective abdominal analgaesіa іn patients
      undergone laparoscopic bariatric surgery. The investigators aimed to compare the analgesic
      effect of erector spinae plane block and opioid based general anesthesia for laparoscopic
      bariatric surgeries.
    

Detailed description: 
      The investigators hypothesized that, erector spinae plane block will provide good analgesia
      for patients undergoing laparoscopic bariatric surgery with less complication compared to
      opioid based general anesthesia. The visual analogue scale (VAS) will be explained clearly to
      all participants before conduction of anesthesia. All the drugs will be calculated according
      to the ideal body weight (IBW).A low-frequency (2-5 MHz) curved array ultrasound probe
      (Mindray®, China) will be used. In the 1st group: bilateral ultrasound-guided erector spinae
      plane block will be performed under complete aseptic conditions in the lateral position at T7
      vertebrae and before induction of general anesthesia. An 8-cm echogenic 22-G block needle
      will be inserted in-plane. A total of 20 ml of local anesthetic solution (20 ml bupivacaine
      (Sunnypivacaine, Sunny pharmaceutical, Egypt) 0.25%) will then be injected into the erector
      spinae plane. This procedure will be repeated on the contralateral side taking care not to
      exceed the maximum recommended doses (2 mg/kg of IBW for bupivacaine). In the 2nd group: the
      investigator will give intravenous nalbuphine in a dose of 2mg /kg according to ideal body
      weight after induction of general anesthesia. All participants will be given 1 gram of
      intravenous paracetamol (15 mg/Kg), together with 4 mg ondansetron 10 min prior to the end of
      surgery for postoperative nausea and vomiting prophylaxis.

      Intraoperatively, any increase in heart rate and/or arterial blood pressure 10 min after
      intubation by more than 20% of baseline values in response to surgical stimulus or thereafter
      throughout the whole operation will be managed by intravenous administration of fentanyl 0.5
      µg/Kg. VAS score will be assessed 30 min after extubation and when the VAS score exceeded
      4/10, rescue analgesia in the form of IV nalbuphine 5 mg will be administered. Another dose
      of rescue analgesia can be given in the post anesthesia care unit (PACU) if the VAS still
      more than 4 after 60 min of extubation. If still high, Ketorolac 60 mg will be given by
      intravenous infusion.
    

Intervention name(s): bilateral ultrasound guided erector spinae plane block; Nalbuphine
Intervention type(s): Procedure; Drug
Intervention description(s): ESPB on both sides at T7 before GA; in nalbuphine for analgesia after GA
Other intervention name(s): ESPB; GA
Intervention MeSH terms: Nalbuphine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: erector spinae plane block group (ESPB)
general anesthesia group (GA)
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: ultrasound guided regional blocks; laparoscopic surgery; erector spinae plane block