Erector Spinae Plane Block and its Impact on Postoperative Diaphragmatic Dysfunction in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Double-Blind Randomized Control Trial - Report - MDSpire
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Erector Spinae Plane Block and its Impact on Postoperative Diaphragmatic Dysfunction in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Double-Blind Randomized Control Trial
Effect of Erector Spinae Plane Block on Diaphragmatic Function Post-Laparoscopic Sleeve Gastrectomy
Overview
This double-blind randomized controlled trial evaluated the impact of erector spinae plane block (ESPB) on diaphragmatic function in patients with class III obesity undergoing laparoscopic sleeve gastrectomy. The study found that ESPB significantly reduced the incidence of postoperative diaphragmatic dysfunction and improved pulmonary function parameters compared to controls.
Background
Class III obesity (BMI > 40 kg/m2) poses significant health risks and often requires bariatric surgery such as laparoscopic sleeve gastrectomy for effective weight loss. Postoperative diaphragmatic dysfunction, defined as diaphragmatic excursion less than 10 mm, is a common complication that contributes to respiratory impairment. Pain and laparoscopic surgery factors exacerbate pulmonary dysfunction, highlighting the need for effective analgesic strategies. The erector spinae plane block (ESPB) is a regional anesthesia technique hypothesized to improve diaphragmatic function postoperatively but had not been previously studied in this context.
Data Highlights
Parameter
Control Group (n=40)
ESPB Group (n=41)
Incidence of Diaphragmatic Dysfunction (MDE <10 mm) at 2h Postop
Higher (exact % not provided)
Significantly Lower
FEV1 (Forced Expiratory Volume in 1s)
Decreased postoperatively
Improved compared to control
FVC (Forced Vital Capacity)
Decreased postoperatively
Improved compared to control
PEFR (Peak Expiratory Flow Rate)
Decreased postoperatively
Improved compared to control
Postoperative Pain Scores (NRS)
Higher at multiple time points
Lower at PACU, 1, 2, 6, and 24 h
24-h Nalbuphine Consumption
Higher
Lower
Key Findings
ESPB significantly reduced the incidence of postoperative diaphragmatic dysfunction (MDE < 10 mm) at 2 hours after surgery.
Patients receiving ESPB demonstrated better preservation of pulmonary function parameters (FEV1, FVC, PEFR) at 2 and 24 hours postoperatively.
Postoperative pain scores were consistently lower in the ESPB group at all measured time points up to 24 hours.
ESPB group required less rescue analgesia (nalbuphine) within the first 24 hours post-surgery.
Diaphragmatic excursion measured by ultrasound was better maintained in patients receiving ESPB compared to controls.
Clinical Implications
The use of ESPB in patients with class III obesity undergoing laparoscopic sleeve gastrectomy can effectively reduce postoperative diaphragmatic dysfunction and improve respiratory outcomes. Incorporating ESPB into multimodal analgesia protocols may enhance pain control and reduce opioid requirements, thereby potentially decreasing pulmonary complications in this high-risk population.
Conclusion
This study provides the first randomized controlled evidence that ESPB improves diaphragmatic function and pulmonary outcomes following laparoscopic sleeve gastrectomy in morbidly obese patients. ESPB represents a valuable regional anesthesia technique to optimize postoperative respiratory function and analgesia in this setting.
References
Author/Source/2025 -- The Effect of Erector Spinae Plane Block on Diaphragmatic Function After Laparoscopic Sleeve Gastrectomy in Patients with Morbid Obesity
