Comparison Between Erector Spinae Plane Block at T9 Level and Transversus Abdominis Plane Block for Postoperative Analgesia and Recovery in Patients with Obesity Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial.

Introduction: Effective postoperative analgesia is essential for recovery after bariatric surgery. This study examines whether T9 erector spinae plane (ESP) block provides better analgesia and recovery than subcostal transversus abdominis plane (TAP) block in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG).

Methods: Patients undergoing LSG were randomized to receive either ESP or TAP blocks. The primary outcome was pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included sensory blockade levels, opioid consumption (morphine equivalents), need for rescue analgesia, and recovery milestones.

Results: Among 168 patients, median age was 29.0 years (ESP) vs 31.0 years (TAP) (p = 0.135), with most being female (67.9% ESP, 65.5% TAP) (p = 0.743). Median BMI was 36.7 kg/m² (ESP) vs 37.1 kg/m² (TAP) (p = 0.819). Patients receiving ESP blocks consistently reported lower NRS scores postoperatively (p = 0.002 and p < 0.001). Sensory blockade in the ESP group was more consistent (84.5% at T6-T12), whereas the TAP group exhibited greater variability (p < 0.001). Opioid consumption within 48 h was lower in the ESP group (median reduction of 8 mg) (p < 0.001). Moreover, ESP group patients needed less rescue analgesia (p = 0.001) and demonstrated faster functional recovery (p < 0.001).

Conclusions: For patients with obesity undergoing LSG, ultrasound-guided ESP block at T9 enhances postoperative analgesia and accelerates recovery compared to subcostal TAP block. While the difference in NRS scores was modest, ESP's ability to reduce opioid use and promote faster recovery highlights its clinical advantage.