Effects of Erector Spinal Plane block (esp) on pain and perioperative stress response in patients undergoing gastric sleeve surgery

Introduction and Aim: In this study, we aimed to see how much bilateral erector spinae plane block (ESPb) affects postoperative analgesia need, patient and surgeon satisfaction, postoperative stress response and blood values in ASA II-III patients with BMI>30 who are planned to undergo sleeve gastrectomy surgery. Materials and Methods: This study was conducted with the approval of Şanlıurfa Harran University Hospital Clinical Research Ethics Committee dated 23.01.2023 and decision number HRÜ/23.02.09, and in accordance with the Declaration of Helsinki, by obtaining written and verbal permission from the patients, gastric sleeve surgery was performed under elective conditions and under general anesthesia. It was planned as a prospective, randomized and single-blind study on 60 volunteer General Surgery patients, aged 18-65, BMI >30, and ASA II-III, who were to be operated on due to surgery. The patients were divided into two: cases that would undergo ESPb (Group E, n:30) and cases that would not undergo ESPb (Group K, n:30). In both groups, demographic data (age, gender, weight, height, BMI), operation time, ASA score and comorbidities were recorded. In both groups, one tube of blood was taken into a purple-capped hemogram tube and a yellow-capped biochemistry tube before the operation. In hemogram analysis, patients' white blood cell (WBC), lymphocyte and neutrophil measurements; In biochemistry analysis, CRP, Cortisol and Glucose measurements of the patients were recorded. All cases were monitored with electrocardiography (ECG), pulse oximetry (SpO2) and noninvasive blood pressure (NIBP) measurement before general anesthesia, and intraoperative vital parameters [heart rate (HR), SpO2, NIBP] were recorded. In the postoperative period, heart rate (HR), mean arterial pressure (MAP), Numerical Pain Scale (NRS) score, patient and surgeon satisfaction with Likert scale, how much opioid is needed for post-operative analgesia, and preoperative and postoperative hemogram values (WBC). , lymphocyte, neutrophil) and biochemistry values (CRP, glucose, cortisol), side effects and complications were noted. xv Results: All data of the 60 cases we included in the study were analyzed. In our study, although there was no significant difference in terms of demographic data (age, gender, weight, height, BMI) between the two groups, age, BMI and surgery duration were found to be statistically lower in Group E. No significant difference was observed in terms of comorbidities between both groups. There was no significant difference in HR and MAP between the two groups in the intraoperative and postoperative periods. In our study, the NRS scores we examined at the 0th, 2nd, 8th and 24th hours postoperatively were found to be statistically significantly lower in Group E. The satisfaction score of patients and surgeons was higher in Group E than in Group K. The amount of tramadol HCl given to patients in addition to dexketoprofen in the postoperative period in the ward was statistically significantly less in Group E. It was observed that cortisol levels increased significantly less in Group E than in Group K, especially at the 8th postoperative hour. No significant difference was seen between the groups in the side effect evaluation. Conclusion: According to the results of our study, ESPb applied in the preoperative period is effective in patients undergoing sleeve gastrectomy surgery; We demonstrated that it reduces pain in the postoperative period, lowers NRS values, increases patient and surgeon satisfaction, and reduces total opioid consumption. In addition, we observed ESPb and the inflammatory response associated with surgical stress with a lesser increase in cortisol levels. For this reason, we think that ESPb should be used as a part of multimodal analgesia in Gastric Sleeve surgeries.