Comparison of the Efficacy of Celiac Plexus Blockade, ESP and Lidocaine Infusion Under OFA
Comparison of the Efficacy of Celiac Plexus Blockade, Erector Spinae Compartment Blockade (ESP), and Intravenous Lidocaine Infusion Under Opioid-free Anesthesia in Patients Undergoing Bariatric Surgery
Jagiellonian University
300 participants
Feb 6, 2025
INTERVENTIONAL
Conditions
Summary
Modern anesthesiology, in search of alternatives to opioid-based pain management, is turning to low-opioid and non-opioid protocols. Replacing opioids with non-opioid analgesics, co-analgesics, and regional and local anesthesia techniques allows avoiding the adverse effects of opioids while maintaining satisfactory analgesia. This is of particular importance in bariatric surgery, where reducing the incidence of respiratory depression, sedation, opioid hyperalgesia, and postoperative nausea and vomiting is a priority. Standard non-opioid anesthesia (OFA) includes ketamine, lidocaine, and dexmedetomidine infusions, while regional techniques additionally reduce the need for analgesics. Despite the widespread use of these methods, there is no clear data on the superiority of any of them in bariatric procedures.
Eligibility
Inclusion Criteria2
- Patients over 18 years who underwent laparoscopic bariatric surgery
- Must be able to sign agreement for study
Exclusion Criteria13
- Patients with a history of allergic reactions to drugs
- Patients with a history of drug addiction
- Patients with chronic pain who require analgesics
- History of hospitalization for psychiatric disorders
- Preoperative pulse oximetry (SpO2) \< 95 %
- bradycardia (HR\<50bpm)
- hypotension
- atrioventricular block
- intraventricular or sinus block
- Blood clotting disorders
- Pregnant/lactating women
- Cognitive impairment
- Unable to read consent
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Interventions
During general anesthesia, a celiac plexus block will be performed intraoperatively (20 ml of 0.5% ropivacaine). The patient will not feel discomfort due to general anesthesia.
Before the procedure, a block of the erector spinae (ESP) compartment will be performed with approximately 20 ml of 0.25% ropivacaine at the Th4 level. The patient will be informed about the possibility of short-term discomfort if the block is performed before full induction of anesthesia.
Instead of a regional block, an intravenous infusion of lidocaine will be used.
Locations(1)
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NCT06793527