Comparison between paragastric blockade and intraperitoneal local anesthetic instillation for the treatment of visceral pain and associated autonomic symptoms following sleeve gastrectomy

Abstract

Background: Visceral pain (VP) and its associated autonomic symptoms (AAS) are common in the immediate postoperative period following sleeve gastrectomy (SG). Intraperitoneal local anesthetic instillation (IPLA) is often used to treat VP. Promising results with paragastric autonomic neural blockade (PG-ANB) were reported in 2022.
Objective: The aim of this study was to compare the efficacy PG-ANB with IPLA and a control group in managing visceral pain and associated autonomic symptoms following SG.
Material and methods: We conducted a prospective, double-blind, randomized clinical trial in a highvolume center over a 9-month period. A total of 192 patients undergoing SG were included (101 women and 91 men) and assigned to three groups: PG-ANB (n = 85), IPLA (n = 96), and NIAT (n = 11). Pain scores, nausea, and vomiting at 8 and 24 hours after surgery were investigated.
Results: At 8 hours, the PG-ANB group experienced less pain than the control group (85.9% vs. 54.5%, Fisher’s exact test 0.023; p < 0.05), with no significant differences compared to the IPLA group (85.9% vs. 80.2%, Fisher’s exact test 0.3308; p > 0.05). The occurrence of associated autonomic symptoms was significantly lower in the PG-ANB group compared to the IPLA group (2.4% vs. 21.9%, Fisher’s exact test = 0.0001; p < 0.05). No differences were observed at 24 hours. There were no complications associated with PG-ANB or IPLA. The control group was terminated for ethical reasons.
Conclusion: PG-ANB was a safe and effective technique for preventing VP and AAS after SG.