Paragastric autonomic neural blockade for pain after laparoscopic sleeve gastrectomy: A systematic review of randomized controlled trials.

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, effective for sustained weight loss and improving obesity-related comorbidities. However, postoperative visceral pain and postoperative nausea and vomiting (PONV) remain significant challenges that adversely affect recovery and patient outcomes. Current analgesic strategies, especially opioid-based approaches, often inadequately address visceral pain and may exacerbate PONV. Paragastric autonomic neural blockade (PG-ANB) is a novel technique aimed at directly targeting pain pathways, aligning with enhanced recovery after surgery (ERAS) principles. Methods: A systematic review of MEDLINE, Cochrane Library, and PubMed databases identified randomized controlled trials (RCTs) evaluating PG-ANB in LSG. Eligible studies were assessed for clinical outcomes, including pain scores, PONV rates, and analgesic requirements. Results: Four studies were included, showing that PG-ANB significantly reduced postoperative pain scores at multiple intervals (1, 6, and 12 h). The PONV rates were lower in the first 8 h, with reduced use of rescue antiemetics. Moreover, PG-ANB decreased opioid requirements and facilitated earlier mobilization. Intraoperative reductions in heart rate and mean arterial pressure 10 min after PG-ANB suggested effective autonomic blockade. Minor complications, bleeding, and hematoma formation were self-limited. Conclusion: Paragastric autonomic neural blockade is effective in managing early postoperative pain and PONV after LSG, reducing opioid use and enhancing recovery. Future research should explore its long-term benefits, optimize its duration of effect, and validate findings in larger and broader populations.