Combined Thoracic Spinal-Epidural Anesthesia for Laparoscopic Sleeve Gastrectomy; One Hundred Case Experience.

BACKGROUND: Obesity is a growingly impacting human health concern. Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for morbid obesity. However, the general anesthesia (GA) used in this major surgery has its documented drawbacks in obese patients with high risk. On the other hand, combined thoracic spinal-epidural anesthesia (CTSEA), a modern regional anesthesia procedure, has the advantages of both spinal and epidural anesthesia but without their shortcomings. This prospective study is a case experience that assesses the feasibility of CTSEA as an anesthesia option for laparoscopic sleeve gastrectomy (LSG). METHODS: A total of 100 patients were recruited for LSG as a management procedure for morbid obesity, which was performed under CTSEA. Perioperative events, functional parameters, and patients' satisfaction scores were recorded. RESULTS: Our prospective study showed successful use of CTSEA in 99% of the patients, except for one patient (1%) in whom CTSEA was converted into GA due to severe pain and anxiety. Few adverse events occurred and were managed accordingly. The satisfaction score revealed that 94% of the patients were satisfied. CONCLUSIONS: CTSEA was a successful anesthetic alternative procedure for LSG surgery.

Ultrasound-Guided Serratus Plane Block Versus Erector Spinae Block for Postoperative Analgesia After Video-Assisted Thoracoscopy: A Pilot Randomized Controlled Trial.

OBJECTIVE: There is no gold standard for the management of postoperative pain after video-assisted thoracoscopic surgery (VATS). Interfascial nerve blocks were proposed as simple and effective options. DESIGN: The present pilot randomized trial aimed to compare the perioperative analgesic effect of ultrasound-guided erector spinae plane block (ESB) with serratus plane block (SPB) in patients undergoing VATS. SETTING: University hospitals. PARTICIPANTS: Sixty adult patients scheduled to undergo VATS were enrolled in the study. INTERVENTIONS: Patients were randomly assigned in a 1:1 ratio to receive either single-shot ultrasound-guided ESB or SPB. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were pain severity, time to first postoperative analgesia, and intraoperative and postoperative analgesic requirements. Data analysis was performed with MedCalc, Version 15.8 (MedCalc, Ostend, Belgium. The ESB group showed a significantly lower VASstatic score than the SPB group from the 4th hour (p = 0.04) to the 6th hour postoperatively (p = 0.002), and the VASdynamic score was significantly lower in ESB group than the SPB group because the patients were alert (p < 0.001); this trend was consistent until the 20th hour postoperatively. Similarly, the time for first required analgesic was significantly longer in the ESB group (p < 0.001). The mean arterial pressure was significantly higher in the SPB group than in the ESB group 12 hours postoperatively (p < 0.001). No major side effects were observed in either of the study groups. CONCLUSION: ESB provided superior analgesia and longer time to first required analgesic than did SPB.