IBC-Oxford University2023_BJSOral_5Comparative Effectiveness of Bupivacaine-Dexamethasone and Liposomal Bupivacaine for Autonomic Neural Blockade in Laparoscopic Sleeve Gastrectomy: A Study on Pain, Postoperative Nausea and Vomiting and Analgesic Consumption

Abstract

Abstract Background Pain is increasingly recognised as a syndrome not merely a symptom, emphasizing the importance of pain management. Visceral pain impacts up to 75% of bariatric patients during recovery. Concurrently, postoperative nausea and vomiting (PONV) persist as challenges after laparoscopic sleeve gastrectomy (LSG). An earlier RCT demonstrated the safety and effectiveness of para-gastric autonomic neural blockade (ANB) as a novel strategy to manage these issues in the first 24 hours after a laparoscopic sleeve gastrectomy. A limitation of using bupivacaine for ANB is its half-life, with clinical effects limited to 14 to 18 hours. This study compares the effectiveness of ANB using a combination of bupivacaine and Dexamethasone with that of liposomal bupivacaine. Methods This research represents a secondary analysis of an earlier RCT titled "Impact on Anaesthetic Agents Consumption Following Autonomic Neural Blockade as Part of a Combined Anaesthesia Protocol," currently under review. This secondary analysis focuses on two patient groups; one where ANB was performed with a mix of 5% bupivacaine and Dexamethasone (47 patients), and another with liposomal bupivacaine (25 patients). Data on pain, PONV, and analgesic requirements at 1, 8, and 24 hour post-surgery were recorded and analysed. Results Both treatment groups demonstrated low levels of pain, PONV incidence, and analgesic usage. No significant differences in pain scores or analgesic use were found between the groups at the selected postoperative time points. However, the liposomal bupivacaine group exhibited a reduced incidence of PONV, statistically significant only for vomiting. Discussion Visceral pain and PONV significantly affects patients' quality of life, recovery time, nursing time allocation, the risk of opioid abuse and readmission rates. Various strategies have been explored to manage visceral pain and associated symptoms. ANB has proven safe and effective in reducing pain, PONV, and analgesic consumption post-LSG. This study confirms that application of either 5 % bupivacaine plus Dexamethasone or liposomal bupivacaine during ANB results in very low levels of pain, PONV incidence, and analgesic use, outperforming the results of the original RCT using only 5% bupivacaine. These results may be attributed to the local anaesthetic used or the improved proficiency in performing the ANB. The similar low pain level and analgesic needs in both groups may render any statistical difference undetected due to the sample size. However, liposomal bupivacaine demonstrated a clinical advantage in reducing PONV after LSG. Conclusion ANB utilizing 5% bupivacaine plus Dexamethasone or liposomal bupivacaine effectively mitigates pain, PONV, and analgesic use following LSG. Liposomal bupivacaine appears more effective in managing nausea and vomiting.