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NCT Number: NCT07431905

Effect of Erector Spinae Plane Block on Postoperative Analgesia and Stress Response in Laparoscopic Sleeve Gastrectomy

Effective postoperative analgesia is an important component of enhanced recovery after bariatric surgery. The erector spinae plane block (ESPB) is a regional anesthesia technique that has been increasingly used in abdominal and thoracic surgeries; however, its effects on postoperative analgesic requirements, pain scores, patient and surgeon satisfaction, hemodynamic parameters, and perioperative stress response in obese patients undergoing sleeve gastrectomy require further evaluation.

This study is designed as a prospective, randomized, single-blind clinical trial. After obtaining ethics committee approval (Şanlıurfa Harran University Hospital, date: 23.01.2023; decision no: HRÜ/23.02.09) and written/verbal informed consent, 60 patients aged 18-65 years, with a body mass index (BMI) >30 and classified as ASA II-III, scheduled for elective sleeve gastrectomy will be included. Patients will be randomized into two groups: a group receiving bilateral ESPB (Group E, n=30) and a control group without ESPB (Group C, n=30).

Demographic characteristics, ASA classification, comorbidities, and duration of surgery will be recorded. Preoperative venous blood samples will be collected for hemogram (white blood cell count, lymphocyte count, neutrophil count) and biochemical analyses (C-reactive protein, cortisol, and glucose). Standard intraoperative monitoring (electrocardiography, peripheral oxygen saturation, and noninvasive blood pressure) will be applied, and heart rate (HR) and mean arterial pressure (MAP) will be recorded intraoperatively.

Postoperatively, HR and MAP, Numerical Rating Scale (NRS) pain scores at 0, 2, 4, 8, and 24 hours, opioid consumption, patient and surgeon satisfaction scores (Likert scale), postoperative hemogram and biochemical parameters, and any side effects or complications will be documented. All patients will receive dexketoprofen as baseline analgesia, and tramadol hydrochloride will be administered as rescue analgesic when required.

The primary objective of the study is to compare postoperative pain scores and analgesic requirements between patients receiving bilateral ESPB and those not receiving ESPB. Secondary objectives include the assessment of hemodynamic parameters, patient and surgeon satisfaction, and perioperative hematologic, biochemical, and stress-related parameters.

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Key information

Conditions

Bariatric Sleeve Gastrectomy Cortisol Erector Spina Plan Block Numerical Rating Scale Opioid Analgesia

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Harran University

Adana, 01360, Turkey (Türkiye)

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age between 18 and 65 years
  • Body mass index (BMI) > 30 kg/m²
  • ASA physical status II-III
  • Scheduled for elective laparoscopic sleeve gastrectomy under general anesthesia
  • Ability to provide written and verbal informed consent

Exclusion criteria

  • Age < 18 years or > 65 years
  • ASA physical status I, IV, or V
  • Body mass index (BMI) < 30 kg/m²
  • Contraindications to erector spinae plane block (e.g., infection at injection site, coagulopathy, allergy to local anesthetics)
  • Renal or hepatic insufficiency
  • Refusal to participate or inability to provide informed consent

Treatment and study plan

Erector Spinae Plane Block

Procedure

Patients in the intervention group received a preoperative bilateral ultrasound-guided erector spinae plane block (ESPB) in addition to standardized general anesthesia and multimodal analgesia. The block was performed 30 minutes before surgery in the preoperative area by an experienced anesthesiologist under aseptic conditions. With the patient in the prone position, a linear ultrasound probe was placed at the T7-T8 vertebral level to identify the transverse process and erector spinae muscle. Using an in-plane technique, a 22-gauge, 100-mm needle was advanced to the transverse process, and 20 mL of a local anesthetic mixture (lidocaine 2%, bupivacaine 0.25%, and saline) was injected into the fascial plane deep to the erector spinae muscle on each side. Dermatomal sensory assessment was performed before transfer to the operating room. All patients subsequently underwent identical general anesthesia protocols. The control group did not receive any regional block and was managed with the

Control

Procedure

Patients allocated to the control group received standardized general anesthesia and postoperative multimodal analgesia without any regional anesthesia technique. No erector spinae plane block or other peripheral nerve block was performed. General anesthesia induction and maintenance protocols were identical to those used in the intervention group, ensuring comparable intraoperative management. At the end of surgery, all patients received intravenous tramadol as part of the standardized analgesic regimen. Postoperatively, scheduled non-opioid analgesia was administered to all patients. Intravenous tramadol was provided as rescue analgesia when Numerical Rating Scale (NRS) pain scores were ≥4 or upon patient request. Perioperative monitoring, postoperative assessments, and data collection procedures were identical between groups.

Primary outcomes

  1. Numerical Rating Scale (NRS)

    Time frame: 24 hours after surgery

    The Numerical Rating Scale is an 11-point scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate worse pain intensity.

Secondary outcomes

  1. Body Weight (kilograms)

    Time frame: At baseline (preoperatively)

    Body weight measured in kilograms (kg) using a calibrated hospital scale. Higher values indicate greater body weight.

  2. Height (centimeters)

    Time frame: At baseline (preoperatively)

    Height measured in centimeters (cm) using a standard stadiometer. Higher values indicate greater height.

  3. Body Mass Index (BMI, kg/m²)

    Time frame: At baseline (preoperatively)

    Calculated as weight (kg) divided by height squared (m²).

  4. Postoperative Rescue Opioid Consumption (Intravenous Tramadol, mg)

    Time frame: During the first 24 hours postoperatively

  5. Perioperative Heart Rate (beats per minute)

    Time frame: Intraoperatively and during the first 24 hours postoperatively

  6. Mean Arterial Pressure (mmHg)

    Time frame: Intraoperatively and during the first 24 hours postoperatively

  7. Patient Satisfaction Assessed by a 5-Point Likert Scale at 24 Hours

    Time frame: 24 hours postoperatively

    5-point Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Higher scores indicate greater satisfaction.

  8. Serum Cortisol Level (mg/dL)

    Time frame: From preoperative baseline to 24 hours postoperatively

  9. Serum C-Reactive Protein (CRP) Level (mg/L)

    Time frame: From preoperative baseline to 24 hours postoperatively

  10. Blood Glucose Level (mg/dL)

    Time frame: From preoperative baseline to 24 hours postoperatively

  11. White Blood Cell Count (×10³/mm³)

    Time frame: From preoperative baseline to 24 hours postoperatively

  12. Lymphocyte Percentage (%)

    Time frame: From preoperative baseline to 24 hours postoperatively

  13. Absolute Lymphocyte Count (×10³/mm³)

    Time frame: From preoperative baseline to 24 hours postoperatively

  14. Neutrophil Percentage (%)

    Time frame: From preoperative baseline to 24 hours postoperatively

  15. Absolute Neutrophil Count (×10³/mm³)

    Time frame: From preoperative baseline to 24 hours postoperatively

Sponsors and collaborators

Lead sponsor

Harran University

Other

Registry information

Official study title

Impact of Erector Spinae Plane Block on Postoperative Analgesia and Perioperative Stress Response in Sleeve Gastrectomy: A Prospective Randomized Clinical Trial

Important dates

Study start
2023
Primary completion
2024
Study completion
2024
First posted
Feb 25, 2026
Registry last updated
Feb 25, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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