{"paper_id":"2d2cabea-a9a2-4864-9c34-d2c89fdf03c4","body_text":"Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Bariatric Surgery: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Bariatric Surgery: A Randomized Controlled Trial Pongkwan Jinaworn, Patt Pannangpetch, Kamonchanok Bunanantanasan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4517150/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Sep, 2024 Read the published version in Obesity Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction : Bariatric surgery advocates multimodal analgesia, discouraging opioid use to minimize side effects such as nausea and vomiting during postoperative pain management for quicker recovery. Combining erector spinae plane block (ESPB) with multimodal analgesia aims to reduce opioid consumption, improving postoperative recovery. This study aimed to compare morphine consumption between patients with morbid obesity undergoing laparoscopic bariatric surgery with and without ESPB. Methods : This study enrolled 91 patients with morbid obesity who underwent laparoscopic bariatric surgery involving either sleeve gastrectomy or gastric bypass. Of these, 63 patients were included in this study. The participants were randomly allocated to either the intervention group, which received an ESPB before the standard anesthesia protocol, or the control group without any pre-anesthesia block. The primary outcome measured was 24-h morphine consumption via a patient-controlled analgesia machine. Secondary outcomes included patients' satisfaction, postoperative numerical rating score, changes over time, and quality of recovery (QoR) using the Thai QoR-35 score. Results : We found no statistically significant difference in morphine consumption between the intervention group, which received an ESPB before the standard anesthesia protocol, and the control group without any pre-anesthesia block. Furthermore, our analysis revealed no significant differences in patient satisfaction, postoperative numeric rating score, or QoR across all five aspects evaluated using the Thai QoR-35 score. Conclusion : ESPB did not reduce morphine consumption and quality of recovery during laparoscopic bariatric surgery. Further studies are required to confirm and identify the reason of the ineffectiveness. Figures Figure 1 Figure 2 Key points Morphine consumption during bariatric surgery was not reduced with ESPB use. There was no difference in pain scores and quality of recovery after ESPB. ESPB may not offer additional benefits in laparoscopic bariatric surgery. Introduction Bariatric surgery is regarded as a cornerstone of obesity treatment, demonstrating efficacy in weight reduction, alleviating obesity-related morbidities, and improving overall well-being [ 10 , 11 ]. Among various procedures, Roux-en-Y gastric bypass and sleeve gastrectomy are the most frequently performed modalities [ 3 ]. Postoperative pain after laparoscopic bariatric surgery is commonly reported to be severe, often reaching a numerical rating scale (NRS) score of 7 or higher within the initial 48 h post-surgery. Despite multimodal analgesic strategies, opioid-based analgesics are frequently necessary for effective pain management, with approximately 41% of patients requiring them [ 21 ]. However, opioid use in this population carries an elevated risk of pulmonary complications, including respiratory depression and obstructive sleep apnea, compared to the general population. Consequently, physicians often strive to minimize opioid use in patients with obesity to reduce the likelihood of adverse respiratory effects. However, inadequate pain management following bariatric surgery can lead to substantial patient discomfort, impaired mobility, and increased susceptibility to complications [ 17 ]. The erector spinae plane block (ESPB) entails precise administration of a local anesthetic under ultrasound guidance, targeting the transverse processes and erector spinae muscles. Despite sharing analgesic mechanisms with epidural or bilateral paravertebral blocks, ESPB offers advantages regarding ease and safety of administration [ 6 , 9 , 19 ]. Given the paucity of research on the efficacy of ESPB for pain management in patients undergoing bariatric surgery, this study aimed to investigate the potential benefits of ESPB in facilitating multimodal analgesia, resulting in reduced opioid consumption as the primary outcome and improved postoperative recovery outcomes as the secondary outcome. We hypothesized that the ESPB could significantly reduce postoperative morphine consumption when compared to without ESPB. Methods This study was approved by the appropriate ethics review board. A single-center, prospective, randomized, single-blind controlled trial was conducted to evaluate the impact of ESPB on opioid consumption in patients undergoing elective laparoscopic bariatric surgery at a hospital between May 2022 and October 2023. Ninety-one eligible patients were scheduled for bariatric surgery, with 18 excluded and 63 enrolled in the study. These individuals were randomly assigned to either the ESPB group (n = 32) or the control group (n = 31) using computer-generated block randomization. The inclusion criteria for this study comprised adults aged 18 years and older scheduled for elective bariatric surgery, with American Society of Anesthesiologists (ASA) physical status classified within the range of class 1 to 3, and who provided voluntary consent to participate. Exclusion criteria involved individuals with hypersensitivity reactions to investigational agents; inability to conduct pain assessments; history of chronic opioid use; incapacity for patient-controlled analgesia (PCA) application; refusal of erector spinae injection; presence of cutaneous infections at injection sites; necessity for postoperative intensive care unit admission with continuous tracheal intubation; pre-existing uncontrolled coagulopathies; and renal, hepatic, cardiovascular, or respiratory pathologies. On the day of surgery, after obtaining informed consent, the attending anesthesiologist opened an allocated envelope to reveal the patient's assigned group. The ESPB group received an ultrasound-guided ESPB at the T7 level, performed by an experienced anesthesiologist who had conducted over 60 similar procedures. The procedure utilized Hitachi-Aloka Arietta 70 ultrasound equipment. Patients were positioned in a seated posture, and after cleaning the procedure area, a curved ultrasound transducer was used to locate the key anatomical landmarks. These included the superior aspect of the T1 vertebral body to identify the position of the first rib, followed by posterior and medial movements to identify the T2 vertebral body and transverse process of the seventh thoracic vertebra (T7 transverse process), respectively. Confirmation of the anatomical landmarks was followed by the insertion of a 21-gauge, 110-mL Sonotap® (Pajunk, Geisingen, Germany) needle using an in-plane technique in the cranial to caudal direction. The needle tip was placed under the erector spinae muscle and above the T7 transverse process, where 2–3 mL of 0.9% NaCl solution was injected for hydrodissection. Elevation of the erector spinae muscle layer above the transverse process confirmed correct needle placement, after which an anesthetic consisting of 0.25% bupivacaine mixed with adrenaline (1:200,000) was injected at this position. The procedure was replicated on the contralateral side, with each side receiving 25 mL of anesthetic solution. The control group only received general anesthesia. The patient was positioned supine, and general anesthesia was administered under standard protocols without premedication. Vital signs were monitored as per ASA guidelines. Preoxygenation involved delivering oxygen to all patients at a rate of 6 L/min for 3 min before induction with propofol at a dose ranging from 2–4 mg/kg, excluding the fat mass. Muscle relaxants for intubation included succinylcholine at a dose of 1 mg/kg of total body weight, followed by maintenance of muscle relaxation using cisatracurium or rocuronium. Anesthesia maintenance involved desflurane in an oxygen and air mixture at a total flow rate of 1 L/min, with an oxygen fraction (FiO2) of 0.5. Desflurane concentration was adjusted between 4–6% of end-tidal gas to maintain a bispectral index (BIS) level between 40–60. Intraoperative opioid was fixed to fentanyl if heart rate (HR) or mean arterial pressure (MAP) increased by more than 20% from baseline and did not exceed 2 µg/kg (excluding fat mass). Thirty min before the conclusion of surgery, 1 g of intravenous paracetamol and 40 mg of parecoxib were administered to all the patients as part of a multimodal regimen. Before suturing the incisions, local wound infiltration was performed with 0.25% bupivacaine. Ondansetron (8 mg) was administered intravenously as postoperative antiemetic prophylaxis. Following extubation, patients were transferred to the recovery room in a semi-upright position and supplied with oxygen through a nasal cannula at a rate of 3 L/min or continuous positive airway pressure (CPAP) at the discretion of the recovery room physician. Pain levels were evaluated using NRS during periods of rest and activity or deep breathing at 0, 1, 6, 12, 18, and 24 h post-surgery. In cases where patients experienced pain in the recovery room, intravenous fentanyl was administered at a dosage of 25 µg every 15 min until the pain score dropped below 4, with the total administered fentanyl recorded as post-anesthesia care unit (PACU) fentanyl. Once baseline pain was controlled, both patient groups received PCA with morphine without a basal rate. Patients could self-administer morphine at a rate of 1 mg every 6 min, up to a maximum of 30 mg within a 4-h period. Multimodal analgesia was employed in both groups, consisting of intravenous paracetamol at a dose of 1 g every 8 h for 1 d (totaling 3 g) and intravenous parecoxib at a dose of 40 mg once 12 h after the initial administration of parecoxib in the operating room. Patients who experienced nausea or vomiting received intravenous ondansetron at a dosage of 8 mg every 6 h. Postoperative morphine consumption at 24 h post-surgery was recorded, and the quality of recovery (QoR) was assessed 24 h after surgery using the Thai QoR-35 questionnaire, validated in the local language [ 15 ]. Patient satisfaction with postoperative pain management was evaluated using a − 5 to 5 rating scale where 5 represented \"very satisfied,\" −5 indicated \"very dissatisfied,\" and 0 represented \"neutral.\" Sample size and statistical analysis The sample size for this study was determined to evaluate two independent continuous outcomes, employing an alpha of 0.05, where Z(1-alpha) = 1.96, and 80% power with Z(1-beta) = 0.84. Previous findings revealed that patients undergoing bariatric surgery received a median (interquartile range [IQR]) opioid dose of 21 mg (17–26.25) within 24 h post-surgery, whereas those in the ESPB group received a median (IQR) of 8 mg (7–9) [ 14 , 20 ]. The respective calculated means (standard deviation [SD]) were 21.42 (7.2) mg and 8 (1.56) mg, with a pooled SD of 5.21. To achieve a greater than 20% reduction in opioid use, statistical significance was established. Initially, the calculated sample size for each group was 27, with a subsequent increase of 10% to 30 participants per group and 60 participants for the study. Basic demographic data of the volunteers, consisting of categorical data reported as frequencies or percentages and continuous variables reported as means and SDs, were analyzed to assess group differences using either the chi-square or Fisher’s exact test for quantitative data, with the independent t-test employed for normally distributed data and the Mann–Whitney U-test for non-normally distributed data. Analyses of morphine and fentanyl usage, numerical pain scale scores at various post-surgery time points, duration of PCA machine usage, desflurane consumption during surgery, quality of recovery, postoperative nausea and vomiting incidents, and patient satisfaction scores using the Thai QoR-35 scores were conducted using a linear mixed-effect model. Results Ninety-one patients were initially assessed for eligibility. Of these, 17 did not meet the inclusion criteria, one declined participation, and 10 could not enroll because of staff availability. Subsequently, 63 patients were enrolled and allocated into two groups: 32 and 31 patients in the ESPB and control groups, respectively. One participant from each group was excluded due to protocol violations, with one patient in the ESPB group experiencing severe pain at the block site and receiving an additional analgesic outside the protocol and another patient in the control group not receiving parecoxib intraoperatively due to suspected ST elevation. Ultimately, 61 patients completed the study (Fig. 1 ). Baseline patient data and types of surgery were comparable between the groups (Table 1 ). Table 1 Patients' characteristics Variables ESPB group (n = 31) Control group (n = 30) p-value Sex Male 14 (45.2) 14 (46.7) 0.906 Female 17 (54.8) 16 (53.3) Age (years) 36.06 ± 9.41 35.80 ± 8.53 0.909 BMI (kg/m 2 ) 44.37 ± 8.51 44.32 ± 7.34 0.979 ASA physical status 2 1 (3.2) 1 (3.3) 1.000 3 30 (96.8) 29 (96.7) Underlying diseases Diabetic mellitus 13 (41.9) 15 (50.0) 0.527 Hypertension 20 (64.5) 18 (60.0) 0.716 Dyslipidemia 14 (45.2) 7 (23.3) 0.073 OSA 27 (87.1) 29 (96.7) 0.354 Liver disease (NASH/NAFLD) 19 (61.3) 15 (50.0) 0.375 Psychotic disorder 0 (0.0) 1 (3.3) 0.492 Type of surgery LSG 17 (54.8) 16 (53.3) 0.205 LRYGB 13 (41.9) 9 (30.0) LSG and DJB 1 (3.2) 5 (16.7) Data are presented as numbers (%), mean ± standard deviation, or median (interquartile range). P-value corresponds to the independent samples t-test, Mann–Whitney U test, chi-square test, or Fisher’s exact test. BMI, body mass index; ASA, American Society of Anesthesiologists; OSA, obstructive sleep apnea; ESPB, erector spinae plane block; NASH, nonalcoholic steatohepatitis; NAFLD, nonalcoholic fatty liver disease; LSG, laparoscopic sleeve gastrectomy; LRYGB, laparoscopic Roux-en-Y gastric bypass; DJB, duodenojejunostomy. Intraoperatively, no significant differences were observed in the duration of surgery, anesthetic time, or intraoperative desflurane consumption. Median (IQR) of intraoperative fentanyl consumption was significantly lower in the ESPB group (100 [80–125] µg) compared to the control group (125 [100–150] µg), with a median difference of -25 (95% confidence interval [CI], − 49.64–−0.36; p = 0.047). (Table 2 ). Table 2 Intraoperative and PACU data of participants Variables ESPB group (n = 31) Control group (n = 30) Absolute difference (95% CI) p-value Total blood loss (mL) 20 (10–30) 20 (10–50) 0.00 (− 15.49–15.49)† 1.000 Total fluid administration (mL) 850 (700–1000) 925 (600–1200) −50.00 (− 282.32–182.32)† 0.668 Total operative time (min) 118 (94–171) 139.5 (90–227) −22.00 (− 77.29–33.29)† 0.429 Total anesthetic time (min) 160 (132–206) 163.5 (131–270) −4.00 (− 59.01–51.01)† 0.885 Intraoperative fentanyl consumption (µg) 100 (80–125) 125 (100–150) −25.00 (− 49.64–−0.36)† 0.047 Intraoperative desflurane (mL) 68.8 (45.0–84.5) 74.5 (57.1–113.4) −6.50 (− 33.52–20.52)† 0.632 Intraoperative desflurane (mL/min) 0.38 (0.31–0.46) 0.41 (0.37–0.50) −0.03 (− 0.11–0.05)† 0.434 PACU fentanyl consumption (µg) 50 (25–75) 50 (25–75) 0.00 (− 25.95–25.95)† 1.000 Data are presented as median (interquartile range). †Absolute difference is the median difference with 95% CIs from a median regression model. ESPB, erector spinae plane block; PACU, postanesthetic care unit; CI, confidence interval. Postoperatively, no statistically significant differences were observed in total morphine consumption between the ESPB and control groups within the first 24 h (Table 3 ). Additionally, no statistically significant differences were observed in the Thai QoR-35 total score or its subdimensions (Table 3 ). Table 3 Postoperative outcome of participants Variables ESPB group (n = 31) Control group (n = 30) Absolute difference Effect estimate (95% CI) p-value Time to 1st PCA trigger (min) 60.5 (37–84) 61.5 (40–83) 0.00 (− 23.43–23.43)† 1.000 Morphine consumption 24 h (mg) 13.0 (6–23) 14.5 (7–24) −2.00 (− 10.82–6.82)† 0.652 Thai QoR-35 Comfort 49.87 ± 6.64 49.47 ± 6.30 0.40 (− 2.91–3.72)‡ 0.808 Emotions 30.87 ± 3.15 29.80 ± 3.16 1.07 (− 0.54–2.69)‡ 0.190 Physical independence 16.35 ± 2.97 15.27 ± 4.18 1.09 (− 0.76–2.94)‡ 0.245 Patient support 28.61 ± 2.54 28.23 ± 2.74 0.38 (− 0.97–1.73)‡ 0.576 Pain 25.39 ± 2.63 25.50 ± 3.71 −0.11 (− 1.76–1.53)‡ 0.891 Total score 151.1 ± 13.37 148.27 ± 14.03 2.83 (− 4.19–9.85)‡ 0.423 Nausea/vomiting No 18 (58.1) 12 (40.0) Yes, no treatment 4 (12.9) 6 (20.0) 0.44 (0.10–1.92) a 0.277 N/V with treatment 9 (29.0) 12 (40.0) 0.50 (0.16–1.55) a 0.230 Patient satisfaction score 4.68 ± 0.54 4.47 ± 1.14 0.21 (-0.24–0.66)‡ 0.356 Data are presented as numbers (%), mean ± standard deviation, or median (interquartile range). †Absolute difference is the median difference with 95% CIs from a median regression model. ‡Absolute difference is the mean difference with 95% CIs from a linear regression model. a Effect estimate is the odds ratio (two-sided 95% CI) from a multinomial logistic regression model. ESPB, erector spinae plane block; PCA, patient-controlled analgesia; OoR, quality of recovery; N/V, nausea and vomiting; CI, confidence interval. Regarding postoperative pain, mean NRS pain scores at rest and during movement showed no significant differences between the ESPB and control groups (Table 4 ). Changes in NRS pain scores within 24 h, analyzed using a linear mixed-effects model adjusted for baseline values, revealed significant differences between the groups at 6 and 12 h postoperatively (Table 5 ) (Fig. 2 ). Table 4 Postoperative NRS pain scores Outcome Baseline 1 h 6 h 12 h 18 h 24 h Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Pain score (NRS) at rest ESPB group 4.71 ± 2.78 2.87 ± 2.05 2.90 ± 1.83 2.19 ± 1.35 1.55 ± 1.21 1.39 ± 1.26 Control group 4.00 ± 2.83 2.27 ± 1.57 3.47 ± 1.93 2.73 ± 2.02 1.93 ± 1.48 1.53 ± 1.57 Pain score (NRS) at movement ESPB group 5.61 ± 2.85 3.65 ± 2.17 4.16 ± 1.92 3.45 ± 1.55 2.97 ± 1.58 2.77 ± 1.50 Control group 4.77 ± 2.79 3.57 ± 1.91 4.87 ± 1.59 4.33 ± 1.79 3.37 ± 1.38 3.03 ± 1.69 Data are presented as mean ± SD. NRS, numerical rating scale; ESPB, erector spinae plane block; SD, standard deviation. Table 5 Changes in postoperative NRS scores over time Outcome ESPB group (n = 31) Control group (n = 30) Difference between groups (95% CI) p-value Change from baseline (95% CI) Change from baseline (95% CI) Pain score (NRS) at rest Baseline Reference Reference 1 h −1.84 (− 2.54–−1.14) −1.73 (− 2.44–−1.02) −0.11 (− 1.10–0.89) 0.836 6 h −1.81 (− 2.52–−1.09) −0.53 (− 1.26–0.19) −1.27 (− 2.29–−0.25) 0.014 12 h −2.52 (− 3.28–−1.75) −1.27 (− 2.04–−0.49) −1.25 (− 2.34–−0.16) 0.024 18 h −3.16 (− 3.99–−2.33) −2.07 (− 2.91–−1.22) −1.10 (− 2.28–0.09) 0.071 24 h −3.32 (− 4.25–−2.40) −2.47 (− 3.41–−1.53) −0.86 (− 2.17–0.46) 0.203 Pain score (NRS) at movement Baseline Reference Reference 1 h −1.97 (− 2.66–−1.27) −1.20 (− 1.91–−0.49) −0.77 (− 1.76–0.22) 0.129 6 h −1.45 (− 2.17–−0.73) 0.10 (− 0.63–0.83) −1.55 (− 2.58–−0.53) 0.003 12 h −2.16 (− 2.95–−1.37) −0.43 (− 1.23–0.37) −1.73 (− 2.85–−0.61) 0.003 18 h −2.65 (− 3.54–−1.75) −1.40 (− 2.31–−0.49) −1.25 (− 2.51–0.02) 0.055 24 h −2.84 (− 3.86–−1.82) −1.73 (− 2.77–−0.70) −1.11 (− 2.56–0.35) 0.135 Analyses were conducted using a linear mixed-effects model with an exchangeable correlation matrix adjusted for baseline values. ESPB, erector spinae plane block; NRS, numerical rating scale; CI, confidence interval. No procedure-related complications, such as nerve injury, pneumothorax, hematoma formation, or local anesthetic systemic toxicity, were reported during the study. Discussion Our study's findings indicated no difference in perioperative morphine consumption and pain scores, contrary to Mostafa et al.'s study, which showed lower opioid use in the ESPB group [ 14 ]. However, our results align with Wang et al.'s findings, which found no significant differences in total QoR and postoperative analgesic consumption [ 20 ]. Furthermore, considering the multimodal analgesia employed in our study, ESPB may not offer additional benefits in laparoscopic bariatric surgery. Epidural anesthesia and paravertebral blocks are effective pain treatments that can lower postoperative opioid consumption. However, performing such procedures in patients with morbid obesity is potentially challenging for anesthesiologists. ESPB has emerged as an effective alternative method for postoperative pain management in laparoscopic bariatric surgery and reduced perioperative opioid usage in previous studies [ 2 , 14 ]. However, the exact mechanism of action remains unclear, and its efficacy in sensory blockade is debatable. The anticipated analgesic effect of ESPB involves the anterior diffusion of local anesthetics from the ESP through intertransverse connective tissue channels into the paravertebral space, potentially acting on ventral rami and spinal nerve roots, as supported by anatomical studies [ 1 , 5 ]. Conflict ing evidence from cadaveric and radiologic studies suggests unpredictable spread of the anterior rami of spinal nerves following ESPB [ 4 , 7 , 12 ]. A previous partial autopsy study showed no dye staining in the intercostal nerve or the paravertebral space [ 4 ]. Additionally, another study reported no changes in somatosensory evoked potentials monitored after ESPB [ 16 ], indicating insufficient distribution of local anesthetic to the paravertebral space. This may have contributed to the inadequate analgesia observed in our study. Moreover, interfascial techniques inherently exhibit a failure rate, which may have influenced our findings [ 13 , 19 ]. The volume of local anesthetic used in ESPB varied across studies. This study used 25 ml of 0.25% bupivacaine for ESPB on each side following the previous study, indicating positive results [ 14 ]. However, one study reported negative results even when 30 ml of the solution was used [ 20 ]. Anesthetic care for patients with morbid obesity poses challenges such as perioperative pain management and addressing pre-existing comorbidities, particularly respiratory issues, and potential psychological concerns. Therefore, this study evaluated outcomes by measuring patient satisfaction and overall quality of care using the Thai QoR-35 questionnaire, a validated Thai-translated version of the English QoR-40. The absence of significant differences in patient satisfaction and Thai QoR-35 scores between the groups likely reflects the consistent postoperative pain levels observed. The estimated complication rate associated with ESPB is low, approximately 2 cases per 10,000 patients [ 8 ]. In this study, complications from nerve block punctures were minimal except for severe postoperative pain at the injection site in one patient. Toprak et al. also reported discontinuation of the procedure in two patients due to discomfort following unilateral block, preventing bilateral application [ 18 ]. However, this study has a few limitations. Firstly, the inability to blind participants due to the absence of a sham block in the control group, concerns regarding potential block-related complications, such as local anesthetic toxicity, and challenges in positioning obese patients for awake and sitting block applications. Nevertheless, blinding was maintained among surgeons, attending anesthesiologists, outcome assessors, and data analysts, all uninvolved in the ESPB procedure. Secondly, this study did not confirm the exact surface distribution of the block area, limiting the comprehensive evaluation of ESPB effects. Thirdly, this study enrolled all types of bariatric surgery and had unequal distribution in the number of each type, which might have affected the pain intensity. Finally, multimodal analgesia in postoperative pain management was encouraged for all patients at our institute. Intravenous paracetamol and parecoxib were arranged by attending anesthesiologists, and routine local anesthetic infiltration was provided by surgeons. These interventions may have conferred additional analgesic effects and significantly reduced pain scores and morphine requirements during the postoperative period. Conclusion Our study revealed no differences in perioperative opioid consumption, QoR scores, or pain scores when ESPB was employed as a supplementary technique alongside general anesthesia for laparoscopic bariatric surgery. Further studies are required to confirm and identify the reason of this ineffectiveness. Declarations Ethics approval: This study received approval from the Institutional Review Board of Chulalongkorn University, Bangkok, Thailand (IRB No. 1042/64) issued on February 10, 2022, and was registered with the Thai Clinical Trials Registry (TCTR 20220523001, URL: https://www.clinicaltrials.in.th/TCTR20220523001) issued on May 23, 2022. Informed consent: Informed consent was obtained from all individual participants included in the study. Funding: This study received no specific grant from any funding agency. Author Contribution Pongkwan Jinaworn and Patt Pannangpetch participated in the research design, the data collection, the interpretation of data, and the data analysis. Kamonchanok Bunanantanasan, Siwaporn Manomaisantiphap and Suthep Udomsawaengsup participated in the research design and the performance. Marvin Thepsoparn and Pipat Saeyup participated in the interpretation of data and writing of the manuscript. All authors reviewed the manuscript. Acknowledgement We thank Editage (www.editage.com) for the English language editing. References Adhikary SD, Bernard S, Lopez H, et al. Erector Spinae Plane Block Versus Retrolaminar Block. Regional Anesthesia and Pain Medicine. 2018;43:756-62. Altıparmak B, Korkmaz Toker M, Uysal AI, et al. 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Cite Share Download PDF Status: Published Journal Publication published 26 Sep, 2024 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 05 Aug, 2024 Reviews received at journal 31 Jul, 2024 Reviewers agreed at journal 16 Jul, 2024 Reviewers invited by journal 16 Jul, 2024 Editor assigned by journal 02 Jul, 2024 Submission checks completed at journal 14 Jun, 2024 First submitted to journal 02 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4517150\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":314308901,\"identity\":\"5c9088ae-8f81-463b-bf12-0fb7eb903822\",\"order_by\":0,\"name\":\"Pongkwan Jinaworn\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pongkwan\",\"middleName\":\"\",\"lastName\":\"Jinaworn\",\"suffix\":\"\"},{\"id\":314308903,\"identity\":\"f9813d92-c936-4886-b9be-cafc19dad695\",\"order_by\":1,\"name\":\"Patt Pannangpetch\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Patt\",\"middleName\":\"\",\"lastName\":\"Pannangpetch\",\"suffix\":\"\"},{\"id\":314308904,\"identity\":\"c54c196f-a9c5-454d-b5e4-17f93c168680\",\"order_by\":2,\"name\":\"Kamonchanok Bunanantanasan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kamonchanok\",\"middleName\":\"\",\"lastName\":\"Bunanantanasan\",\"suffix\":\"\"},{\"id\":314308905,\"identity\":\"d404213d-3c81-4571-a1a9-1562a75e09e2\",\"order_by\":3,\"name\":\"Siwaporn Manomaisantiphap\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Siwaporn\",\"middleName\":\"\",\"lastName\":\"Manomaisantiphap\",\"suffix\":\"\"},{\"id\":314308906,\"identity\":\"2853723c-a7db-4d9f-abb2-86e49d1dc4ab\",\"order_by\":4,\"name\":\"Suthep Udomsawaengsup\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Suthep\",\"middleName\":\"\",\"lastName\":\"Udomsawaengsup\",\"suffix\":\"\"},{\"id\":314308907,\"identity\":\"4f54ca99-a408-4ab9-a56d-df3a3940823d\",\"order_by\":5,\"name\":\"Marvin Thepsoparn\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Chulalongkorn University, King Chulalongkorn Memorial Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Marvin\",\"middleName\":\"\",\"lastName\":\"Thepsoparn\",\"suffix\":\"\"},{\"id\":314308909,\"identity\":\"3b6787f6-cc90-40c2-aa87-9f8aa428c97c\",\"order_by\":6,\"name\":\"Pipat Saeyup\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYDACZgST8QGQ4OEjSssBKNMApIWNKJugWtgkwCQh1ebsvAc/f/hjJ2dwI/dY5dccOxk2BuaHj27g0WLZzJcscbAt2djgRl7abdltyUCHsRkb5+DRYnCYx0DiYANz4oYbOWa3JbcxA7XwsEkT0GL848Cf+nqQlmLJbfVEaTGTOMB2OMEAqIXx47bDhLUA/ZJmcbbtuOHMM++SpRm3HedhYybgF3P+s4dvVPypluc7nnvw489t1fb87M0PH+N1GAMPhKFwgIeBGcxmxqMcRYt8Aw8D4w8CqkfBKBgFo2BkAgAe30gHKHLqLgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Kyoto Prefectural University of Medicine Hospital, Kyoto Prefectural University of Medicine\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Pipat\",\"middleName\":\"\",\"lastName\":\"Saeyup\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-06-02 13:23:16\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4517150/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4517150/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1007/s11695-024-07515-8\",\"type\":\"published\",\"date\":\"2024-09-26T15:57:38+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":60197606,\"identity\":\"0ef3ab4a-989c-4bea-ba55-0dd29c78a202\",\"added_by\":\"auto\",\"created_at\":\"2024-07-13 01:58:13\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":424391,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eConsort diagram of the study participants\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4517150/v1/83166990268af2867988466a.jpg\"},{\"id\":60197604,\"identity\":\"1afc0966-e3ba-40a1-be71-c9700b9d0a08\",\"added_by\":\"auto\",\"created_at\":\"2024-07-13 01:58:13\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":165815,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChanges in mean postoperative numerical rating scale (NRS) scores over time\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FIgure2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4517150/v1/01d7366d1b28cf642aed65c1.jpg\"},{\"id\":65628033,\"identity\":\"eba7c0c3-e502-4f0c-bc8d-a2c874e4f8ff\",\"added_by\":\"auto\",\"created_at\":\"2024-09-30 16:17:12\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1304303,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4517150/v1/c9af8694-031f-4b41-9981-f1ed468c278e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Bariatric Surgery: A Randomized Controlled Trial\",\"fulltext\":[{\"header\":\"Key points\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003eMorphine consumption during bariatric surgery was not reduced with ESPB use.\\u003c/li\\u003e\\n \\u003cli\\u003eThere was no difference in pain scores and quality of recovery after ESPB.\\u003c/li\\u003e\\n \\u003cli\\u003eESPB may not offer additional benefits in laparoscopic bariatric surgery.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eBariatric surgery is regarded as a cornerstone of obesity treatment, demonstrating efficacy in weight reduction, alleviating obesity-related morbidities, and improving overall well-being [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Among various procedures, Roux-en-Y gastric bypass and sleeve gastrectomy are the most frequently performed modalities [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePostoperative pain after laparoscopic bariatric surgery is commonly reported to be severe, often reaching a numerical rating scale (NRS) score of 7 or higher within the initial 48 h post-surgery. Despite multimodal analgesic strategies, opioid-based analgesics are frequently necessary for effective pain management, with approximately 41% of patients requiring them [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. However, opioid use in this population carries an elevated risk of pulmonary complications, including respiratory depression and obstructive sleep apnea, compared to the general population. Consequently, physicians often strive to minimize opioid use in patients with obesity to reduce the likelihood of adverse respiratory effects. However, inadequate pain management following bariatric surgery can lead to substantial patient discomfort, impaired mobility, and increased susceptibility to complications [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe erector spinae plane block (ESPB) entails precise administration of a local anesthetic under ultrasound guidance, targeting the transverse processes and erector spinae muscles. Despite sharing analgesic mechanisms with epidural or bilateral paravertebral blocks, ESPB offers advantages regarding ease and safety of administration [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eGiven the paucity of research on the efficacy of ESPB for pain management in patients undergoing bariatric surgery, this study aimed to investigate the potential benefits of ESPB in facilitating multimodal analgesia, resulting in reduced opioid consumption as the primary outcome and improved postoperative recovery outcomes as the secondary outcome. We hypothesized that the ESPB could significantly reduce postoperative morphine consumption when compared to without ESPB.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e This study was approved by the appropriate ethics review board. A single-center, prospective, randomized, single-blind controlled trial was conducted to evaluate the impact of ESPB on opioid consumption in patients undergoing elective laparoscopic bariatric surgery at a hospital between May 2022 and October 2023. Ninety-one eligible patients were scheduled for bariatric surgery, with 18 excluded and 63 enrolled in the study. These individuals were randomly assigned to either the ESPB group (n\\u0026thinsp;=\\u0026thinsp;32) or the control group (n\\u0026thinsp;=\\u0026thinsp;31) using computer-generated block randomization.\\u003c/p\\u003e \\u003cp\\u003eThe inclusion criteria for this study comprised adults aged 18 years and older scheduled for elective bariatric surgery, with American Society of Anesthesiologists (ASA) physical status classified within the range of class 1 to 3, and who provided voluntary consent to participate. Exclusion criteria involved individuals with hypersensitivity reactions to investigational agents; inability to conduct pain assessments; history of chronic opioid use; incapacity for patient-controlled analgesia (PCA) application; refusal of erector spinae injection; presence of cutaneous infections at injection sites; necessity for postoperative intensive care unit admission with continuous tracheal intubation; pre-existing uncontrolled coagulopathies; and renal, hepatic, cardiovascular, or respiratory pathologies.\\u003c/p\\u003e \\u003cp\\u003eOn the day of surgery, after obtaining informed consent, the attending anesthesiologist opened an allocated envelope to reveal the patient's assigned group. The ESPB group received an ultrasound-guided ESPB at the T7 level, performed by an experienced anesthesiologist who had conducted over 60 similar procedures. The procedure utilized Hitachi-Aloka Arietta 70 ultrasound equipment. Patients were positioned in a seated posture, and after cleaning the procedure area, a curved ultrasound transducer was used to locate the key anatomical landmarks. These included the superior aspect of the T1 vertebral body to identify the position of the first rib, followed by posterior and medial movements to identify the T2 vertebral body and transverse process of the seventh thoracic vertebra (T7 transverse process), respectively. Confirmation of the anatomical landmarks was followed by the insertion of a 21-gauge, 110-mL Sonotap\\u0026reg; (Pajunk, Geisingen, Germany) needle using an in-plane technique in the cranial to caudal direction. The needle tip was placed under the erector spinae muscle and above the T7 transverse process, where 2\\u0026ndash;3 mL of 0.9% NaCl solution was injected for hydrodissection. Elevation of the erector spinae muscle layer above the transverse process confirmed correct needle placement, after which an anesthetic consisting of 0.25% bupivacaine mixed with adrenaline (1:200,000) was injected at this position. The procedure was replicated on the contralateral side, with each side receiving 25 mL of anesthetic solution. The control group only received general anesthesia.\\u003c/p\\u003e \\u003cp\\u003eThe patient was positioned supine, and general anesthesia was administered under standard protocols without premedication. Vital signs were monitored as per ASA guidelines. Preoxygenation involved delivering oxygen to all patients at a rate of 6 L/min for 3 min before induction with propofol at a dose ranging from 2\\u0026ndash;4 mg/kg, excluding the fat mass. Muscle relaxants for intubation included succinylcholine at a dose of 1 mg/kg of total body weight, followed by maintenance of muscle relaxation using cisatracurium or rocuronium. Anesthesia maintenance involved desflurane in an oxygen and air mixture at a total flow rate of 1 L/min, with an oxygen fraction (FiO2) of 0.5. Desflurane concentration was adjusted between 4\\u0026ndash;6% of end-tidal gas to maintain a bispectral index (BIS) level between 40\\u0026ndash;60. Intraoperative opioid was fixed to fentanyl if heart rate (HR) or mean arterial pressure (MAP) increased by more than 20% from baseline and did not exceed 2 \\u0026micro;g/kg (excluding fat mass). Thirty min before the conclusion of surgery, 1 g of intravenous paracetamol and 40 mg of parecoxib were administered to all the patients as part of a multimodal regimen. Before suturing the incisions, local wound infiltration was performed with 0.25% bupivacaine. Ondansetron (8 mg) was administered intravenously as postoperative antiemetic prophylaxis.\\u003c/p\\u003e \\u003cp\\u003eFollowing extubation, patients were transferred to the recovery room in a semi-upright position and supplied with oxygen through a nasal cannula at a rate of 3 L/min or continuous positive airway pressure (CPAP) at the discretion of the recovery room physician. Pain levels were evaluated using NRS during periods of rest and activity or deep breathing at 0, 1, 6, 12, 18, and 24 h post-surgery. In cases where patients experienced pain in the recovery room, intravenous fentanyl was administered at a dosage of 25 \\u0026micro;g every 15 min until the pain score dropped below 4, with the total administered fentanyl recorded as post-anesthesia care unit (PACU) fentanyl. Once baseline pain was controlled, both patient groups received PCA with morphine without a basal rate. Patients could self-administer morphine at a rate of 1 mg every 6 min, up to a maximum of 30 mg within a 4-h period. Multimodal analgesia was employed in both groups, consisting of intravenous paracetamol at a dose of 1 g every 8 h for 1 d (totaling 3 g) and intravenous parecoxib at a dose of 40 mg once 12 h after the initial administration of parecoxib in the operating room. Patients who experienced nausea or vomiting received intravenous ondansetron at a dosage of 8 mg every 6 h.\\u003c/p\\u003e \\u003cp\\u003ePostoperative morphine consumption at 24 h post-surgery was recorded, and the quality of recovery (QoR) was assessed 24 h after surgery using the Thai QoR-35 questionnaire, validated in the local language [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Patient satisfaction with postoperative pain management was evaluated using a \\u0026minus;\\u0026thinsp;5 to 5 rating scale where 5 represented \\\"very satisfied,\\\" \\u0026minus;5 indicated \\\"very dissatisfied,\\\" and 0 represented \\\"neutral.\\\"\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSample size and statistical analysis\\u003c/h2\\u003e \\u003cp\\u003eThe sample size for this study was determined to evaluate two independent continuous outcomes, employing an alpha of 0.05, where Z(1-alpha)\\u0026thinsp;=\\u0026thinsp;1.96, and 80% power with Z(1-beta)\\u0026thinsp;=\\u0026thinsp;0.84. Previous findings revealed that patients undergoing bariatric surgery received a median (interquartile range [IQR]) opioid dose of 21 mg (17\\u0026ndash;26.25) within 24 h post-surgery, whereas those in the ESPB group received a median (IQR) of 8 mg (7\\u0026ndash;9) [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. The respective calculated means (standard deviation [SD]) were 21.42 (7.2) mg and 8 (1.56) mg, with a pooled SD of 5.21. To achieve a greater than 20% reduction in opioid use, statistical significance was established. Initially, the calculated sample size for each group was 27, with a subsequent increase of 10% to 30 participants per group and 60 participants for the study.\\u003c/p\\u003e \\u003cp\\u003eBasic demographic data of the volunteers, consisting of categorical data reported as frequencies or percentages and continuous variables reported as means and SDs, were analyzed to assess group differences using either the chi-square or Fisher\\u0026rsquo;s exact test for quantitative data, with the independent t-test employed for normally distributed data and the Mann\\u0026ndash;Whitney U-test for non-normally distributed data. Analyses of morphine and fentanyl usage, numerical pain scale scores at various post-surgery time points, duration of PCA machine usage, desflurane consumption during surgery, quality of recovery, postoperative nausea and vomiting incidents, and patient satisfaction scores using the Thai QoR-35 scores were conducted using a linear mixed-effect model.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eNinety-one patients were initially assessed for eligibility. Of these, 17 did not meet the inclusion criteria, one declined participation, and 10 could not enroll because of staff availability. Subsequently, 63 patients were enrolled and allocated into two groups: 32 and 31 patients in the ESPB and control groups, respectively. One participant from each group was excluded due to protocol violations, with one patient in the ESPB group experiencing severe pain at the block site and receiving an additional analgesic outside the protocol and another patient in the control group not receiving parecoxib intraoperatively due to suspected ST elevation. Ultimately, 61 patients completed the study (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Baseline patient data and types of surgery were comparable between the groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePatients' characteristics\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eESPB group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;31)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eControl group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;30)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(45.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(46.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.906\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(54.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e36.06\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e35.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.909\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e44.37\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e44.32\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.979\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eASA physical status\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(3.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(96.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(96.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderlying diseases\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetic mellitus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(41.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.527\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(64.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.716\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDyslipidemia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(45.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(23.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.073\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(87.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(96.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.354\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLiver disease (NASH/NAFLD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(61.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.375\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePsychotic disorder\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(0.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.492\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eType of surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLSG\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(54.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(53.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.205\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLRYGB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(41.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(30.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLSG and DJB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(3.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eData are presented as numbers (%), mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation, or median (interquartile range).\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eP-value corresponds to the independent samples t-test, Mann\\u0026ndash;Whitney U test, chi-square test, or Fisher\\u0026rsquo;s exact test.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eBMI, body mass index; ASA, American Society of Anesthesiologists; OSA, obstructive sleep apnea; ESPB, erector spinae plane block; NASH, nonalcoholic steatohepatitis; NAFLD, nonalcoholic fatty liver disease; LSG, laparoscopic sleeve gastrectomy; LRYGB, laparoscopic Roux-en-Y gastric bypass; DJB, duodenojejunostomy.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eIntraoperatively, no significant differences were observed in the duration of surgery, anesthetic time, or intraoperative desflurane consumption. Median (IQR) of intraoperative fentanyl consumption was significantly lower in the ESPB group (100 [80\\u0026ndash;125] \\u0026micro;g) compared to the control group (125 [100\\u0026ndash;150] \\u0026micro;g), with a median difference of -25 (95% confidence interval [CI], \\u0026minus;\\u0026thinsp;49.64\\u0026ndash;\\u0026minus;0.36; p\\u0026thinsp;=\\u0026thinsp;0.047). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eIntraoperative and PACU data of participants\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"8\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eESPB group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;31)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eControl group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;30)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eAbsolute difference\\u003c/p\\u003e \\u003cp\\u003e(95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal blood loss (mL)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(10\\u0026ndash;30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(10\\u0026ndash;50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;15.49\\u0026ndash;15.49)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal fluid administration (mL)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e850\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(700\\u0026ndash;1000)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e925\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(600\\u0026ndash;1200)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;50.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;282.32\\u0026ndash;182.32)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.668\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal operative time (min)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e118\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(94\\u0026ndash;171)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e139.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(90\\u0026ndash;227)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;22.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;77.29\\u0026ndash;33.29)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.429\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal anesthetic time (min)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(132\\u0026ndash;206)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e163.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(131\\u0026ndash;270)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;4.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;59.01\\u0026ndash;51.01)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.885\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntraoperative fentanyl consumption (\\u0026micro;g)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e100\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(80\\u0026ndash;125)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e125\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(100\\u0026ndash;150)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;25.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;49.64\\u0026ndash;\\u0026minus;0.36)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.047\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntraoperative desflurane (mL)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e68.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(45.0\\u0026ndash;84.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e74.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(57.1\\u0026ndash;113.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;6.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;33.52\\u0026ndash;20.52)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.632\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntraoperative desflurane (mL/min)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(0.31\\u0026ndash;0.46)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(0.37\\u0026ndash;0.50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;0.11\\u0026ndash;0.05)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.434\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePACU fentanyl consumption (\\u0026micro;g)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(25\\u0026ndash;75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(25\\u0026ndash;75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026minus;\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;25.95\\u0026ndash;25.95)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003eData are presented as median (interquartile range).\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003e\\u0026dagger;Absolute difference is the median difference with 95% CIs from a median regression model.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003eESPB, erector spinae plane block; PACU, postanesthetic care unit; CI, confidence interval.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003ePostoperatively, no statistically significant differences were observed in total morphine consumption between the ESPB and control groups within the first 24 h (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Additionally, no statistically significant differences were observed in the Thai QoR-35 total score or its subdimensions (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePostoperative outcome of participants\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"10\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eESPB group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;31)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eControl group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;30)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003eAbsolute difference\\u003c/p\\u003e \\u003cp\\u003eEffect estimate\\u003c/p\\u003e \\u003cp\\u003e(95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to 1st PCA trigger (min)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e60.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e(37\\u0026ndash;84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e61.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(40\\u0026ndash;83)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;23.43\\u0026ndash;23.43)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMorphine consumption 24 h (mg)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e(6\\u0026ndash;23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(7\\u0026ndash;24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;10.82\\u0026ndash;6.82)\\u0026dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.652\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"10\\\" nameend=\\\"c10\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eThai QoR-35\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eComfort\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e49.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e49.47\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e0.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.91\\u0026ndash;3.72)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.808\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmotions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e30.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e29.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e1.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;0.54\\u0026ndash;2.69)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.190\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical independence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e16.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.97\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e15.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e1.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;0.76\\u0026ndash;2.94)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.245\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePatient support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e28.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e28.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e0.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;0.97\\u0026ndash;1.73)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.576\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e25.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e25.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.71\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.76\\u0026ndash;1.53)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.891\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e151.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e148.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e2.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;4.19\\u0026ndash;9.85)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.423\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"10\\\" nameend=\\\"c10\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNausea/vomiting\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(58.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes, no treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(12.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e0.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(0.10\\u0026ndash;1.92)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.277\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eN/V with treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(29.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e0.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(0.16\\u0026ndash;1.55)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.230\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePatient satisfaction score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e4.68\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003e4.47\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003e0.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e(-0.24\\u0026ndash;0.66)\\u0026Dagger;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.356\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eData are presented as numbers (%), mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation, or median (interquartile range).\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003e\\u0026dagger;Absolute difference is the median difference with 95% CIs from a median regression model.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003e\\u0026Dagger;Absolute difference is the mean difference with 95% CIs from a linear regression model.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eEffect estimate is the odds ratio (two-sided 95% CI) from a multinomial logistic regression model.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eESPB, erector spinae plane block; PCA, patient-controlled analgesia; OoR, quality of recovery; N/V, nausea and vomiting; CI, confidence interval.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eRegarding postoperative pain, mean NRS pain scores at rest and during movement showed no significant differences between the ESPB and control groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). Changes in NRS pain scores within 24 h, analyzed using a linear mixed-effects model adjusted for baseline values, revealed significant differences between the groups at 6 and 12 h postoperatively (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePostoperative NRS pain scores\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 h\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6 h\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12 h\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e18 h\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e24 h\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePain score (NRS) at rest\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eESPB group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.71\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.19\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eControl group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.57\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.47\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.93\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.93\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.57\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePain score (NRS) at movement\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eESPB group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.85\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.65\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.45\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eControl group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.57\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.37\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eNRS, numerical rating scale; ESPB, erector spinae plane block; SD, standard deviation.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eChanges in postoperative NRS scores over time\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"8\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eESPB group (n\\u0026thinsp;=\\u0026thinsp;31)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eControl group (n\\u0026thinsp;=\\u0026thinsp;30)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDifference\\u003c/p\\u003e \\u003cp\\u003ebetween groups\\u003c/p\\u003e \\u003cp\\u003e(95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eChange from \\u003c/p\\u003e \\u003cp\\u003ebaseline (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eChange from \\u003c/p\\u003e \\u003cp\\u003ebaseline (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePain score (NRS) at rest\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c8\\\" namest=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.54\\u0026ndash;\\u0026minus;1.14)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.44\\u0026ndash;\\u0026minus;1.02)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.10\\u0026ndash;0.89)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.836\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e6 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.81\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.52\\u0026ndash;\\u0026minus;1.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.26\\u0026ndash;0.19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.29\\u0026ndash;\\u0026minus;0.25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.014\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e12 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;3.28\\u0026ndash;\\u0026minus;1.75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.04\\u0026ndash;\\u0026minus;0.49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.34\\u0026ndash;\\u0026minus;0.16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e18 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;3.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;3.99\\u0026ndash;\\u0026minus;2.33)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.91\\u0026ndash;\\u0026minus;1.22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.28\\u0026ndash;0.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.071\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e24 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;3.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;4.25\\u0026ndash;\\u0026minus;2.40)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;3.41\\u0026ndash;\\u0026minus;1.53)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.17\\u0026ndash;0.46)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.203\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePain score (NRS) at movement\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eReference\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c8\\\" namest=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.97\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.66\\u0026ndash;\\u0026minus;1.27)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.91\\u0026ndash;\\u0026minus;0.49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.76\\u0026ndash;0.22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.129\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e6 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.17\\u0026ndash;\\u0026minus;0.73)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;0.63\\u0026ndash;0.83)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.58\\u0026ndash;\\u0026minus;0.53)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e12 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.95\\u0026ndash;\\u0026minus;1.37)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;1.23\\u0026ndash;0.37)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.85\\u0026ndash;\\u0026minus;0.61)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e18 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;3.54\\u0026ndash;\\u0026minus;1.75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.31\\u0026ndash;\\u0026minus;0.49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.51\\u0026ndash;0.02)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.055\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e24 h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026minus;2.84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;3.86\\u0026ndash;\\u0026minus;1.82)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.77\\u0026ndash;\\u0026minus;0.70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026minus;1.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(\\u0026minus;\\u0026thinsp;2.56\\u0026ndash;0.35)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.135\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"8\\\"\\u003eAnalyses were conducted using a linear mixed-effects model with an exchangeable correlation matrix adjusted for baseline values. ESPB, erector spinae plane block; NRS, numerical rating scale; CI, confidence interval.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eNo procedure-related complications, such as nerve injury, pneumothorax, hematoma formation, or local anesthetic systemic toxicity, were reported during the study.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOur study's findings indicated no difference in perioperative morphine consumption and pain scores, contrary to Mostafa et al.'s study, which showed lower opioid use in the ESPB group [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. However, our results align with Wang et al.'s findings, which found no significant differences in total QoR and postoperative analgesic consumption [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Furthermore, considering the multimodal analgesia employed in our study, ESPB may not offer additional benefits in laparoscopic bariatric surgery.\\u003c/p\\u003e \\u003cp\\u003eEpidural anesthesia and paravertebral blocks are effective pain treatments that can lower postoperative opioid consumption. However, performing such procedures in patients with morbid obesity is potentially challenging for anesthesiologists. ESPB has emerged as an effective alternative method for postoperative pain management in laparoscopic bariatric surgery and reduced perioperative opioid usage in previous studies [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. However, the exact mechanism of action remains unclear, and its efficacy in sensory blockade is debatable. The anticipated analgesic effect of ESPB involves the anterior diffusion of local anesthetics from the ESP through intertransverse connective tissue channels into the paravertebral space, potentially acting on ventral rami and spinal nerve roots, as supported by anatomical studies [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConflict\\u003c/strong\\u003e \\u003cp\\u003eing evidence from cadaveric and radiologic studies suggests unpredictable spread of the anterior rami of spinal nerves following ESPB [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. A previous partial autopsy study showed no dye staining in the intercostal nerve or the paravertebral space [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Additionally, another study reported no changes in somatosensory evoked potentials monitored after ESPB [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], indicating insufficient distribution of local anesthetic to the paravertebral space. This may have contributed to the inadequate analgesia observed in our study. Moreover, interfascial techniques inherently exhibit a failure rate, which may have influenced our findings [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. The volume of local anesthetic used in ESPB varied across studies. This study used 25 ml of 0.25% bupivacaine for ESPB on each side following the previous study, indicating positive results [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. However, one study reported negative results even when 30 ml of the solution was used [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003eAnesthetic care for patients with morbid obesity poses challenges such as perioperative pain management and addressing pre-existing comorbidities, particularly respiratory issues, and potential psychological concerns. Therefore, this study evaluated outcomes by measuring patient satisfaction and overall quality of care using the Thai QoR-35 questionnaire, a validated Thai-translated version of the English QoR-40. The absence of significant differences in patient satisfaction and Thai QoR-35 scores between the groups likely reflects the consistent postoperative pain levels observed.\\u003c/p\\u003e \\u003cp\\u003eThe estimated complication rate associated with ESPB is low, approximately 2 cases per 10,000 patients [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. In this study, complications from nerve block punctures were minimal except for severe postoperative pain at the injection site in one patient. Toprak et al. also reported discontinuation of the procedure in two patients due to discomfort following unilateral block, preventing bilateral application [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHowever, this study has a few limitations. Firstly, the inability to blind participants due to the absence of a sham block in the control group, concerns regarding potential block-related complications, such as local anesthetic toxicity, and challenges in positioning obese patients for awake and sitting block applications. Nevertheless, blinding was maintained among surgeons, attending anesthesiologists, outcome assessors, and data analysts, all uninvolved in the ESPB procedure. Secondly, this study did not confirm the exact surface distribution of the block area, limiting the comprehensive evaluation of ESPB effects. Thirdly, this study enrolled all types of bariatric surgery and had unequal distribution in the number of each type, which might have affected the pain intensity. Finally, multimodal analgesia in postoperative pain management was encouraged for all patients at our institute. Intravenous paracetamol and parecoxib were arranged by attending anesthesiologists, and routine local anesthetic infiltration was provided by surgeons. These interventions may have conferred additional analgesic effects and significantly reduced pain scores and morphine requirements during the postoperative period.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOur study revealed no differences in perioperative opioid consumption, QoR scores, or pain scores when ESPB was employed as a supplementary technique alongside general anesthesia for laparoscopic bariatric surgery. Further studies are required to confirm and identify the reason of this ineffectiveness.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval: \\u0026nbsp;\\u003c/strong\\u003eThis study received approval from the Institutional Review Board of Chulalongkorn University, Bangkok, Thailand (IRB No. 1042/64) issued on February 10, 2022, and was registered with the Thai Clinical Trials Registry (TCTR 20220523001, URL: https://www.clinicaltrials.in.th/TCTR20220523001) issued on May 23, 2022.\\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eInformed consent:\\u003c/h2\\u003e \\u003cp\\u003e Informed consent was obtained from all individual participants included in the study.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding:\\u003c/h2\\u003e \\u003cp\\u003eThis study received no specific grant from any funding agency.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003ePongkwan Jinaworn and Patt Pannangpetch participated in the research design, the data collection, the interpretation of data, and the data analysis. Kamonchanok Bunanantanasan, Siwaporn Manomaisantiphap and Suthep Udomsawaengsup participated in the research design and the performance. Marvin Thepsoparn and Pipat Saeyup participated in the interpretation of data and writing of the manuscript. All authors reviewed the manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eWe thank Editage (www.editage.com) for the English language editing.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eAdhikary SD, Bernard S, Lopez H, et al. Erector Spinae Plane Block Versus Retrolaminar Block. Regional Anesthesia and Pain Medicine. 2018;43:756-62.\\u003c/li\\u003e\\n\\u003cli\\u003eAltıparmak B, Korkmaz Toker M, Uysal AI, et al. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. Journal of Clinical Anesthesia. 2019;57:31-6.\\u003c/li\\u003e\\n\\u003cli\\u003eAngrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obesity Surgery. 2018;28:3783-94.\\u003c/li\\u003e\\n\\u003cli\\u003eAponte A, Sala-Blanch X, Prats-Galino A, et al. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Canadian Journal of Anesthesia/Journal canadien d\\u0026apos;anesth\\u0026eacute;sie. 2019;66:886-93.\\u003c/li\\u003e\\n\\u003cli\\u003eBonvicini D, Boscolo-Berto R, De Cassai A, et al. Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study. Journal of Anesthesia. 2021;35:102-11.\\u003c/li\\u003e\\n\\u003cli\\u003eChin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery. Regional Anesthesia and Pain Medicine. 2017;42:372-6.\\u003c/li\\u003e\\n\\u003cli\\u003eDautzenberg KHW, Zegers MJ, Bleeker CP, et al. Unpredictable Injectate Spread of the Erector Spinae Plane Block in Human Cadavers. Anesthesia \\u0026amp; Analgesia. 2019;129:e163-6.\\u003c/li\\u003e\\n\\u003cli\\u003eDe Cassai A, Geraldini F, Carere A, et al. Complications Rate Estimation After Thoracic Erector Spinae Plane Block. Journal of Cardiothoracic and Vascular Anesthesia. 2021;35:3142-3.\\u003c/li\\u003e\\n\\u003cli\\u003eForero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block. Regional Anesthesia and Pain Medicine. 2016;41:621-7.\\u003c/li\\u003e\\n\\u003cli\\u003eGarvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care of Patients with Obesity. Endocrine Practice. 2016;22:1-203.\\u003c/li\\u003e\\n\\u003cli\\u003eHeymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. New England Journal of Medicine. 2017;376:254-66.\\u003c/li\\u003e\\n\\u003cli\\u003eIvanusic J, Konishi Y, Barrington MJ. A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade. Regional Anesthesia and Pain Medicine. 2018;43:567-71.\\u003c/li\\u003e\\n\\u003cli\\u003eMelvin JP, Schrot RJ, Chu GM, et al. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Canadian Journal of Anesthesia/Journal canadien d\\u0026apos;anesth\\u0026eacute;sie. 2018;65:1057-65.\\u003c/li\\u003e\\n\\u003cli\\u003eMostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound‐Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial. Pain Practice. 2021;21:445-53.\\u003c/li\\u003e\\n\\u003cli\\u003ePitimana-Aree S, Udompanthurak S, Lapmahapaisan S, et al. Validity and reliability of quality of recovery-35 Thai version: a prospective questionnaire-based study. BMC Anesthesiology. 2015;16.\\u003c/li\\u003e\\n\\u003cli\\u003eSelvi O, Tulgar S, Serifsoy TE, et al. Quadrant and Dermatomal Analysis of Sensorial Block in Ultrasound- Guided Erector Spinae Plane Block. The Eurasian Journal of Medicine. 2022;54:121-6.\\u003c/li\\u003e\\n\\u003cli\\u003eSun X, Yu J, Luo J, et al. Meta-analysis of the association between obstructive sleep apnea and postoperative complications. Sleep Medicine. 2022;91:1-11.\\u003c/li\\u003e\\n\\u003cli\\u003eToprak H, Başaran B, Toprak ŞS, et al. Efficacy of the Erector Spinae Plane Block for Quality of Recovery in Bariatric Surgery: a Randomized Controlled Trial. Obesity Surgery. 2023;33:2640-51.\\u003c/li\\u003e\\n\\u003cli\\u003eTulgar S, Selvi O, Kapakli MS. Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries: Case Series. Case Reports in Anesthesiology. 2018;2018:1-3.\\u003c/li\\u003e\\n\\u003cli\\u003eWang Y, Zuo S, Ma Y, et al. Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial. Clinical Therapeutics. 2023;45:894-900.\\u003c/li\\u003e\\n\\u003cli\\u003eWeingarten TN, Sprung J, Flores A, et al. Opioid Requirements after Laparoscopic Bariatric Surgery. Obesity Surgery. 2011;21:1407-12.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"obesity-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"obsu\",\"sideBox\":\"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)\",\"snPcode\":\"11695\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/11695/3\",\"title\":\"Obesity Surgery\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4517150/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4517150/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eIntroduction\\u003c/strong\\u003e: Bariatric surgery advocates multimodal analgesia, discouraging opioid use to minimize side effects such as nausea and vomiting during postoperative pain management for quicker recovery. Combining erector spinae plane block (ESPB) with multimodal analgesia aims to reduce opioid consumption, improving postoperative recovery. This study aimed to compare morphine consumption between patients with morbid obesity undergoing laparoscopic bariatric surgery with and without ESPB.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e: This study enrolled 91 patients with morbid obesity who underwent laparoscopic bariatric surgery involving either sleeve gastrectomy or gastric bypass. Of these, 63 patients were included in this study. The participants were randomly allocated to either the intervention group, which received an ESPB before the standard anesthesia protocol, or the control group without any pre-anesthesia block. The primary outcome measured was 24-h morphine consumption via a patient-controlled analgesia machine. Secondary outcomes included patients' satisfaction, postoperative numerical rating score, changes over time, and quality of recovery (QoR) using the Thai QoR-35 score.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: We found no statistically significant difference in morphine consumption between the intervention group, which received an ESPB before the standard anesthesia protocol, and the control group without any pre-anesthesia block. Furthermore, our analysis revealed no significant differences in patient satisfaction, postoperative numeric rating score, or QoR across all five aspects evaluated using the Thai QoR-35 score.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: ESPB did not reduce morphine consumption and quality of recovery during laparoscopic bariatric surgery. Further studies are required to confirm and identify the reason of the ineffectiveness.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Bariatric Surgery: A Randomized Controlled Trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-13 01:58:08\",\"doi\":\"10.21203/rs.3.rs-4517150/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-08-05T13:38:44+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-07-31T15:00:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"158629668496822568511441965729735957406\",\"date\":\"2024-07-16T12:26:36+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-07-16T11:51:27+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-07-02T13:16:41+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-06-14T05:51:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Obesity Surgery\",\"date\":\"2024-06-02T13:15:53+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"obesity-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"obsu\",\"sideBox\":\"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)\",\"snPcode\":\"11695\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/11695/3\",\"title\":\"Obesity Surgery\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"c0f267c7-8445-4d6f-8334-4beeb5c39a48\",\"owner\":[],\"postedDate\":\"July 13th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-09-30T16:10:08+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4517150\",\"link\":\"https://doi.org/10.1007/s11695-024-07515-8\",\"journal\":{\"identity\":\"obesity-surgery\",\"isVorOnly\":false,\"title\":\"Obesity Surgery\"},\"publishedOn\":\"2024-09-26 15:57:38\",\"publishedOnDateReadable\":\"September 26th, 2024\"},\"versionCreatedAt\":\"2024-07-13 01:58:08\",\"video\":\"\",\"vorDoi\":\"10.1007/s11695-024-07515-8\",\"vorDoiUrl\":\"https://doi.org/10.1007/s11695-024-07515-8\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4517150\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4517150\",\"identity\":\"rs-4517150\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}