Erector Spinae Block and Transverse Abdominis Plane Block for Sleeve Gasterectomy
Condition: Bariatric Surgery Candidate
Study type: Interventional

Summary: 
      assess the efficacy of ultrasound guided erector spinae block to decrease the requirement for
      analgesics after laparoscopic sleeve gastrectomy and to decrease postoperative pain scores
      and opioid consumption compared to subcostal transverses abdominis block.
    

Detailed description: 
      Primary outcomes

      • Cumulative opioid consumption during the first 24 h postoperatively. For the purpose of
      comparison, all opioids administered postoperatively will be converted to IV morphine
      equivalent doses using standard opioid dosage conversion tables.

      Secondary outcome parameters

        1. Pain assessment by the aid of Visual analogue scale (VAS), which is consisted of a "10
           cm" line with one end labeled no pain and other end labeled worst intolerable pain. The
           patients marked the line at the point that best describing the pain intensity. The
           preoperative assessment included training of the patients about (VAS) for postoperative
           pain. The length of the line to the patient's mark will be measured and recorded
           postoperative after 30 min., 4, 6, 8, and 24 hours.

        2. Failure rate of the block will be calculated, where the block will be considered a
           failed block if the patient requires more than two doses of rescue analgesia in the
           first hour postoperatively.

        3. Duration of surgery (from skin incision till skin closure) and general anesthesia (from
           induction of GA till extubation).

        4. Incidence of complications, such as: Nerve injury, Hematoma formation, LA toxicity, and
           intravascular injection.
    

Intervention name(s): Erector spinae plane block; TAP block
Intervention type(s): Procedure; Procedure
Intervention description(s): the level between T9 and T10 will be identified using ultrasound as well as transverse processes depth. An array probe will be applied longitudinal orientation 3 cm lateral midline. The erector spinae and the psoas muscle will be identified. A skin wheal will be made using lidocaine 1% at each level and then a 22-gauge Tuohy needle will be advanced inplane until it made contact with the transverse process. The needle will be withdrawn slightly and 30cc of bupivacaine 0.25 % (15ml for each side) will be injected slowly after negative aspiration was confirmed. The same procedure will be repeated in the contralateral side.; a linear array transducer 5-12 MHz will be positioned inferior and parallel to the costal margin in a medio-lateral orientation. The external oblique, internal oblique and transverse abdominis muscles will be identified immediately lateral to the linea semilunaris. A a 22-gauge needle will be advanced medially and in-plane to the US beam until the tip lies between the fascia of the internal oblique muscle and the transverse abdominis muscle layers. 30 ml of 0.25 % bupivacaine will be injected in each side and the spread will be observed between the two muscles layers.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Prevention