Paragastric Neural Blockade Effectively Controls Visceral Pain After Primary Laparoscopic Sleeve Gastrectomy.

Background: Surgical advancements and the implementation of Enhanced Recovery After Surgery (ERAS) protocols have contributed to reduced postoperative pain and faster recovery. Despite these improvements in perioperative care, pain remains one of the most distressing symptoms, particularly during the early postoperative period. Visceral pain (VP), rather than somatic pain, is the predominant source of discomfort and is often difficult to manage with standard pain control methods. This study aims to replicate the findings of previous randomized controlled trials (RCTs) on the effectiveness of paragastric neural blockade (PGNB) in controlling VP, addressing the ongoing clinical challenge of inadequate pain control despite standard multimodal analgesia (MMA).

Methods: A retrospective study was conducted from January to September 2024, comparing a control group (standard MMA including transversus abdominis plane [TAP] block, n=50) with a PGNB group (same protocol plus PGNB, n=50). The primary outcome was pain intensity (Numeric rating scale [NRS] score 0-10) within 48 hours post-surgery. Secondary outcomes included time to first analgesic use, cumulative analgesic doses, nausea/vomiting incidence, and hemodynamic changes.

Results: NRS scores were significantly lower in the PGNB group within 8 hours postoperatively (p<0.001). The time to first rescue analgesic use was prolonged (1084.08±902.78 minutes vs. 260.60±482.25 minutes; p<0.001) and the cumulative frequency of analgesic use on the day of surgery was also lower in the PGNB group (0.46 times vs. 1.34 times; p<0.001). No significant differences in the incidence of postoperative nausea and vomiting (PONV) were observed on postoperative days (PODs) 0 and 2, although POD 1 showed higher nausea in the PGNB group (p=0.002). The operative time was significantly longer in the PGNB group (113.90±14.54 minutes vs. 97.86±20.78 minutes; p<0.001). There was one case of localized hematoma at the injection site, which was controlled with local compression and resolved within a few minutes. No other complications were observed.

Conclusion: PGNB effectively reduces VP and the need for rescue analgesics during the early postoperative period following LSG, without any major complications.