Laparoscopic Preperitoneal Local Anesthetic Infiltration Versus Ultrasound Guided Quadratus Lumborum Block in Laparoscopic Bariatric Surgery

Obesity and overweight have become a global epidemic, impacting people of all ages and socioeconomic status. Obesity is still a major public health issue globally, despite progress in some places. Bariatric surgery remains the most effective and long-lasting way to lose weight and address obesity-related conditions.(1) Optimizing postoperative pain treatment is crucial for reducing complications, shortening hospital stays, and lowering expenditures in patients undergoing surgery. Multimodal analgesia and postoperative pain reduction are especially relevant to bariatric surgery patients, who frequently have numerous coexisting conditions and are more vulnerable to thrombotic and respiratory problems. Obstructive sleep apnea (OSA) is common among obese individuals, making safe analgesic treatment problematic. Controlling pain following bariatric surgery is particularly difficult. General management recommendations include multimodal analgesic therapy, regional methods, avoidance of sedatives and early mobilization.(2, 3, 4, 5)

Blanco originally described the quadratus lumborum block (QLB) in 2007. The primary benefit of QLB is the extension of a local anesthetic agent beyond the transversus abdominis plane into the thoracic paravertebral area. The greater distribution of local anesthetic agents may provide significant analgesia and prolong the action of the injected local anesthetic solution.(6)

Preperitoneal local anesthetic injection was initially developed by Dean et al. as a pain management strategy for laparoscopic hernia repair, and it is currently widely used.(7) A recent meta-analysis compared preperitoneal and subcutaneous wound catheters to epidural analgesia. Preperitoneal wound catheters were shown to be as effective as epidural analgesia in abdominal surgeries. Periportal wound catheters appear to be more effective in terms of patient satisfaction and recovery.(8) A recent study concluded that preperitoneal local anesthetic infiltration is effective for relief of postoperative pain in patients undergoing laparoscopic bariatric surgery.(9)

Aim of the work:

The present study aims to compare the analgesic efficacy of ultrasound-guided trans-muscular quadratus lumborum block (QLB) to preperitoneal local anesthetic infiltration during laparoscopic bariatric surgery and in the early postoperative period.