Clinical Scorecard: The Effect of Erector Spinae Plane Block on Diaphragmatic Function After Laparoscopic Sleeve Gastrectomy in Patients with Morbid Obesity: A Double-Blind Randomized Controlled Study

At a Glance

Key Highlights

• Postoperative diaphragmatic dysfunction defined as mean diaphragmatic excursion (MDE) < 10 mm at 2 hours post-surgery.
• Erector spinae plane block (ESPB) administered bilaterally under ultrasound guidance after surgery to potentially reduce diaphragmatic dysfunction.
• Diaphragmatic function assessed via ultrasound and pulmonary function tests (FEV1, FVC, PEFR) preoperatively and postoperatively.

Guideline-Based Recommendations

Diagnosis

• Use diaphragmatic ultrasound to assess diaphragmatic excursion preoperatively and postoperatively.
• Define diaphragmatic dysfunction as MDE less than 10 mm at 2 hours postoperatively.

Management

• Administer bilateral erector spinae plane block under ultrasound guidance postoperatively to reduce diaphragmatic dysfunction.
• Implement standardized multimodal analgesia including IV paracetamol and ketorolac.
• Provide rescue analgesia with IV nalbuphine for pain scores ≥ 4.

Monitoring & Follow-up

• Monitor pain using Numeric Rating Scale (NRS) at PACU and multiple time points up to 24 hours postoperatively.
• Perform pulmonary function tests (FEV1, FVC, PEFR) preoperatively and at 2 and 24 hours post-block.
• Assess diaphragmatic excursion via ultrasound at baseline, 2, and 24 hours postoperatively.

Risks

• Potential for inadequate diaphragmatic ultrasound views limiting assessment.
• Contraindications to nerve block must be considered before ESPB administration.
• Preexisting pulmonary conditions excluded to avoid confounding respiratory impairment.

Patient & Prescribing Data

Adults with class III obesity undergoing laparoscopic sleeve gastrectomy

ESPB combined with multimodal analgesia may reduce postoperative diaphragmatic dysfunction and improve pulmonary outcomes; rescue analgesia provided based on pain severity.

Clinical Best Practices

• Perform ESPB bilaterally under ultrasound guidance at T8 level after surgery while patient remains under general anesthesia.
• Use a local anesthetic mixture of bupivacaine 0.5%, lidocaine 2%, and saline totaling 20 mL per side for ESPB.
• Ensure blinded assessment of diaphragmatic function by experienced operators to reduce bias.
• Apply standardized pain assessment and rescue analgesia protocols to optimize postoperative pain control.
• Exclude patients with preexisting pulmonary disease or contraindications to nerve block to ensure safety and data validity.

References

• Clinical trial registration NCT07022600