Effect of Adding Magnesium Sulphate to Bupivacaine in Laparoscopic Periportal Preperitoneal Local Infiltration in Laparoscopic Sleeve Gastrectomy

Obesity isn't just a cosmetic issue, it is a medical condition, sometimes considered a disease in which excess body fat has accumulated to an extent that can potentially have negative effects on health, The increasing prevalence of obesity has become a significant concern worldwide. It increases the risk of many other diseases and health problems that include heart diseases, diabetes, high blood pressure, fatty liver, apnea, even certain cancers.

Bariatric surgery has become the most effective way to lose weight. Health care providers recommend bariatric surgery if other conservative weight loss methods have failed. Surgical weight loss operations have been performed over the last 20 years. Bariatric surgery procedures include gastric bypass, gastric band, duodenal switch and sleeve gastrectomy, Laparoscopic sleeve gastrectomy (LSG) is an effective procedure for weight loss. It has become the most commonly performed bariatric surgery with low morbidity without long term malabsorptive risks.

In patients undergoing LSG, postoperative pain management is essential for reducing complications due to excessive opioid use, early mobilization and shortening hospital stays, Multimodal analgesia seems to be the gold standard in the treatment of acute pain, particularly for bariatric surgery patients who frequently have numerous coexisting conditions, one of these conditions is obstructive sleep apnea (OSA) which is common among obese individuals, making safe analgesic treatment a bit challenging.

Perioperative multimodal analgesia uses a combination of analgesic medications that act on various sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opioid consumption, The clinical practice trends are now shifting towards opioid sparing anaesthesia.

Local infiltration analgesia is widely used as a component of multimodal analgesia. It involves the injection of a local anaesthetic near the surgical incision site to provide analgesia. Periportal preperitoneal local anaesthetic infiltration is a technique that was first described by Dean et al, for pain relief in laparoscopic hernia repair and is now gaining popularity.