Regional anesthesia in bariatric surgery

Abstract

Purpose of review: Obesity presents significant perioperative challenges, particularly in bariatric surgery, where optimizing pain management while minimizing opioid use is crucial. Recent advancements in regional anesthesia (RA) techniques offer potential benefits in enhancing perioperative outcomes for this high-risk population.

Recent findings: Current evidence supports the use of RA techniques such as transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, erector spinae plane (ESP) block, and intraperitoneal instillation of local anesthetics in reducing postoperative pain and opioid consumption. While TAP and ESP blocks improve postoperative analgesia, the QL block offers longer-lasting pain relief. Intraperitoneal local anesthetic administration has shown potential in decreasing opioid use and improving respiratory recovery. Additionally, port-site infiltration remains a simple yet effective alternative. However, anatomical challenges in obese patients necessitate optimized ultrasound guidance for successful block placement.

Summary: RA is a key component of multimodal analgesia in bariatric surgery, contributing to reduced opioid-related complications and improved recovery. Despite promising findings, further high-quality randomized controlled trials are needed to refine technique selection and enhance clinical outcomes in this patient population.

Keywords: bariatric surgery; multimodal analgesia; obesity; opioid reduction; regional anesthesia.

FIGURE 1.

Ultrasound scan of the region of interest for performing a rectus sheath block in an obese patient. The ‘Cross’ represents the perpendicular distance from the skin to the rectus abdominis muscle, the ‘X’ indicates the hypothetical needle path from the skin to the rectus abdominis muscle, and the ‘Square’ denotes the rectus abdominis muscle.

FIGURE 2.

Ultrasound scan of the region of interest for performing a rectus sheath block in a normal weight patient obese patient. The ‘Cross’ represents the perpendicular distance from the skin to the rectus abdominis muscle, the ‘X’ indicates the hypothetical needle path from the skin to the rectus abdominis muscle, and the ‘Square’ denotes the rectus abdominis muscle.