The impact of regional anesthesia techniques on pain control and opioid consumption in sleeve gastrectomy

The impact of regional anesthesia techniques on pain control and opioid consumption in sleeve gastrectomy | 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 The impact of regional anesthesia techniques on pain control and opioid consumption in sleeve gastrectomy Mehmet Sait Berhuni, Hasan Elkan, Ahmet Atlas, Hüseyin Yönder This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5964286/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives This study aims to evaluate the effectiveness of erector spinae block (ESP) and transversus abdominis plane (TAP) blocks in reducing postoperative opioid requirements and enhancing pain control in laparoscopic sleeve gastrectomy (LSG) patients. Methods This retrospektif study included 90 patients undergoing LSG. The patients were equally allocated into three groups—ESP block, TAP block, and control (no regional anesthesia applied)—with 30 patients in each group. During the allocation process, patients were matched for age and gender. Pain levels were assessed using the Visual Analog Scale (VAS) at 0, 2, 4, 8, 12, and 24 hours postoperatively. Opioid consumption, side effect, patient and surgeon satisfaction were recorded. Statistical analyses were conducted to compare pain scores, opioid use, and satisfaction levels among the groups. Results ESP group demonstrated significantly lower VAS scores compared to the control group. The ESP block group reported the lowest VAS scores, indicating superior pain control. Opioid consumption was significantly reduced in both ESP and TAP block groups compared to the control group, with the ESP group showing the greatest reduction. There was a significant relationship between amount of opioid used and side effects. Patient satisfaction was highest in the ESP block group, followed by the TAP block group, and lowest in the control group. Conclusions The ESP and TAP blocks are effective in reducing postoperative opioid consumption and providing better pain control in LSG patients. The ESP block, in particular, offers superior analgesia and higher patient satisfaction compared to the TAP block and no block. Erector spinae plane block laparoscopic sleeve gastrectomy opioid consumption postoperative pain transversus abdominis plane block Figures Figure 1 Figure 2 Figure 3 1. Introduction Obesity is a global health issue associated with significant morbidity and mortality due to its related comorbidities [ 1 ]. Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery for managing obesity [ 2 ]. Following tissue damage, local inflammatory mediators, such as bradykinin, substance P, prostaglandins, histamine, and serotonin, are released at the surgical site, inducing pain. Impulses from these inflammatory mediators upon tissue destruction activate nociceptors, i.e., free nerve endings that sense pain. Fast, sharp pain is transmitted by myelinated A-delta fibers, whereas slow, chronic pain is carried by unmyelinated C fibers via the spinal cord anterolateral pathway [ 3 ]. The perioperative period is characterized by immune system suppression for inflammatory pain and surgical stress, which inhibits cytotoxic cells [ 4 ]. Multimodal analgesia strategies during this period can benefit immune modulation and minimize immune suppression, thereby reducing postoperative morbidities [ 5 ]. Regional anesthesia techniques as part of multimodal analgesia also modulate the immune response by reducing surgical stress and opioid use, which are known to impair cellular and humoral immunity. This helps protect patients from opioid-related side effects and prevents immunosuppression caused by pain and surgical stress. Effective management of immunosuppressive factors is crucial for shorter hospital stays, a more comfortable postoperative process, and reduced hospital costs [ 4 ]. Postoperative pain management can be complicated by serious side effects, such as respiratory depression, cardiopulmonary arrest, cardiopulmonary arrest, urinary retention, ileus, and addictive potential, of high-dose opioids used for analgesia in patients who undergo bariatric surgery [ 6 , 7 ]. Opioids also suppress the immune system by weakening the cytotoxic functions of natural killer cells [ 8 ]. Therefore, it is important to minimize the use of opioids and to investigate alternative pain management methods to opioids or can be used in combination with opioids [ 9 ]. The Visual analog scale (VAS) is a reliable and valid scale for assessing pain severity in postoperative patients [ 10 ]. The transversus abdominis plane (TAP) block, first described by Rafi in 2001, is an intervention that creates a peripheral nerve block in the anterolateral abdominal wall [ 11 ]. TAP is the space between the internal oblique muscle and the transversus abdominis muscles. An anesthetic is injected into this site for the procedure. Initially, the procedure was performed blindly, but its reliability and success rate have improved with ultrasonography (USG) guidance [ 12 ]. The erector spinae plane (ESP) block, introduced as a technique for managing thoracic neuropathic pain and pain associated with thoracic trauma or surgery [ 13 ], is based on the columnar arrangement of the erector spinae muscle and retinaculum. This concept suggests that ESP block applications at lower thoracic levels might also provide abdominal analgesia [ 14 ]. This study aimed to compare the efficacy of ESP and TAP blocks in reducing the need for postoperative analgesia and opioid use in patients undergoing SG. 2. Materials and Methods Study Design and Patient Population The study was reviewed and approved by the Harran University Clinical Research Ethics Committee (28.12.2023-25). The study was designed as a retrospective study. The patients included in the study were selected from those who underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity in our clinic between January 1, 2023, and June 30, 2023. The patients were equally allocated into three groups—ESP block, TAP block, and control (no regional anesthesia applied)—with 30 patients in each group. During the allocation process, patients were matched for age and gender. All patients underwent LSG by a single general surgeon. Due to the potential need for analgesics in the postoperative recovery unit, the patients were accompanied by the anesthesiologist, who performed the block procedure. Postoperative pain assessment was performed using VAS score at 0, 2, 4, 8, 12, and 24 h after the patient was returned to their room. A Likert type survey was used to assess patient and physician satisfaction with postoperative analgesia. This survey is a routine assessment tool applied to patients who have undergone obesity surgery during their outpatient follow-up visits in our clinic. During the first outpatient clinic control after discharge, the patient was asked, “Considering the pain I experienced after surgery, I would have surgery again if I went back to the preoperative period”; and the physician was asked, “When I evaluate the patient in terms of pain control, the patient was easy to manage.” They were asked to respond both questions with one of the following answers and scored thereafter; Strongly disagree (1 point) Disagree (2 points) Neither agree nor disagree (3 points) Agree (4 points) Strongly agree (5 points) Patients were evaluated by age, sex, body mass index (BMI), American Society of Anesthesiologists physical status classifications (ASA) score, comorbidity, amount of opioid use, VAS score, side effects (urinary retention, cardiopulmonary arrest, respiratory depression and ileus were considered as side effects), patient, and physician satisfaction. Data other than the survey responses were obtained from patient records. Inclusion and Exclusion Criteria Pursuant to the inclusion criteria, patients aged 18–60 years, patients with ASA scores of I, II, and III, and a BMI of > 35 kg/m2 were included in the study. For the exclusion criteria, patients with missing data in their records, patients who were allergic to local anesthetics, refused a regional block, underwent concomitant surgeries, experienced intraoperative or postoperative complications within the first 24 h, had a platelet count of < 100,000, had known coagulopathy, or had a history of opioid addiction. Patients who underwent concomitant surgeries (e.g., cholecystectomy) were excluded from the study due to the potential for increased surgical morbidity and higher analgesic requirements. Additionally, patients with coagulopathy or low platelet counts were excluded due to the elevated risk of bleeding, and individuals with opioid dependence were excluded as they may require higher opioid doses for effective analgesia. General Anesthesia, ESP, and TAP Block Applications At induction of anesthesia, all patients received 2 mg/kg propofol, 0.5 mg/kg atracurium, and 2 mcg/kg fentanyl based on their corrected ideal weight. No additional analgesics or anti-inflammatories were administered. For preoperative antibiotic prophylaxis, 1000 mg of 1st generation cephalosporin was administered intravenously. Regional anesthesia was performed by the same anesthesiologist to ensure consistency in the study results. All regional anesthesia procedures were performed on the operating table upon induction of anesthesia. The control group did not receive regional anesthesia. Intravenous (IV) opioids were used for postoperative analgesia in all groups based on the patient’s needs and VAS scores. ESP Block Application ESP block was performed immediately after induction of anesthesia to investigate its effect on postoperative analgesia. It was performed on the operating table prior to induction of general anesthesia. Overall, 10% povidone–iodine was used for skin preparation. The probe was covered with a sterile drape. All ESP blocks were performed by the same anesthesiologist, who was experienced in ultrasound-guided regional anesthesia techniques. A wide-bandwidth (1–8 MHz) convex probe (Esaote®, MyLab5, Italy) and a 22G, 50 or 100 mm, isolated facet-type needle (Braun Sonoplex, Melsungen, Germany) were used to perform the multifrequency block. Blocks were performed bilaterally using an intraplane approach at the T8 level with the patient in the prone position. The convex probe was placed 2–3 cm lateral to the spine using a sagittal approach. The needle was inserted deeply into the erector spinae muscle after the erector spinae muscle and transverse processes were identified (Fig. 1 ). The correct position of the needle tip was verified by 0.5–1 ml of local anesthetic (LA). 20 ml of 0.25% bupivacaine was administered as local anesthetic to perform the ESP block. local anesthetic spread was confirmed in both cranial and caudal directions. TAP Block Procedure Following the induction of general anesthesia, the surgical site was cleaned with an antiseptic solution on the operating table and a sterile cover was placed over the linear ultrasound probe (Esaote®, MyLab5, Italy). To capture the optimal image, the probe was moved vertically or tilted up and down along the abdominal wall toward the costal margin and iliac crest. The probe was secured in position once it obtained a clear view, spanning from the superficial to deep layers and displaying the skin, subcutaneous fat tissue, external oblique muscle, internal oblique muscle, transversus abdominis muscle fascia, and peritoneum. A 100-mm, 22-G needle (Braun Sonoplex, Melsungen, Germany) was advanced anterior to posterior using an in-plane technique under ultrasound guidance. To confirm proper placement of the needle tip between the fascial planes of the internal oblique and transversus abdominis muscles, careful aspiration was performed. Subsequently, a test dose of 1 mL of 0.25% bupivacaine was administered to confirm proper needle localization (Fig. 2 ). Following this, 20 mL of 0.25% bupivacaine solution was injected simultaneously on both the right and left sides under ultrasound guidance, after which the surgical procedure was initiated. All patients underwent LSG, performed by a single general surgeon. Following surgery, the anesthesiologist who performed the block procedure accompanied the patients in the post-anesthesia care unit to address any potential analgesic needs. Once the patient was transferred to the regular ward, pain assessments were conducted based on the VAS score at 0, 2, 4, 8, 12, and 24 hours after surgery. Statistical Analysis All statistical analyses were performed using SPSS for Windows, version 25.0 (IBM SPSS Inc., Chicago, IL, USA). The Shapiro–Wilk test was employed to assess the normality of the data distribution. As the data did not follow a normal distribution, continuous variables are presented as medians and minimum-maximum, while categorical variables are reported as counts (n) and percentages (%). Between-group comparisons involving more than two independent groups were conducted using the Kruskal–Wallis H test. To evaluate changes in intragroup VAS scores over time (at 2, 4, 8, 12, and 24 hours), the Friedman test was applied, followed by post-hoc pairwise comparisons with Bonferroni correction. The Chi-square test was used for the analysis of categorical variables. All analyses were performed using a 95% confidence interval, and a two-tailed p-value less than 0.05 was considered statistically significant. 3. Results The study including 25 (27.8%) male and 65 (72.2%) female patients. The mean age of the patients was 33.2 ± 9.5 years, where the mean BMI was 46.3 ± 5.3 kg/m². Overall 46 (51.1%) patients were classified as ASA 2 and 44 (48.9%) as ASA 3. There were no significant intergroup differences by age, sex, BMI, ASA score, and comorbidity variables (p > 0.05 for each) (Table 1 ). Table 1 Comparison of Clinical and Demographic Characteristics based on Postoperative Analgesia Methods Overall (n = 90) Group p Control (n = 30) ESP (n = 30) TAP (n = 30) Age † 33.2 ± 9.5 34.5 ± 9.9 29.9 ± 8.6 35.2 ± 9.5 0.054* Sex ‡ Male 25 (27.8) 7 (23.3) 10 (33.3) 8 (26.7) 0.679** Female 65 (72.2) 23 (76.7) 20 (66.7) 22 (73.3) BMI † 46.3 ± 5.3 46.3 ± 6.1 46.3 ± 5.0 46.2 ± 4.7 0.992* ASA Score ‡ 2 46 (51.1) 13 (43.3) 14 (46.7) 19 (63.3) 0.252** 3 44 (48.9) 17 (56.7) 16 (53.3) 11 (36.7) Comorbid Conditions , present ‡ 12 (13.3) 4 (13.3) 4 (13.3) 4 (13.3) 0.999** ESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane, BMI: Body Mass Index, ASA: American Society of Anesthesiologists *. One-way ANOVA. **. Pearson’s Chi-Squared/Fisher–Freeman–Halton test, ‡ : n (%), † : Mean ± Standard deviation There were significant differences between the groups by mean and maximum VAS scores, opioid use, patient, and physician satisfaction (Table 2 ). Table 2 Comparison of VAS Scores, Opioid Use and Satisfaction based on Postoperative Analgesia Methods Overall (n = 90) Group p Control (n = 30) ESP (n = 30) TAP (n = 30) VAS Median § 3.7 [0.3–7.5] 4.3 [1.3–6.5] 3.2 [0.3–5.2] 3.9 [2.2–7.5] 0.037* VAS Max. § 6.0 [2.0–10.0] 7.0 [2.0–10.0] 5.0 [2.0–9.0] 6.0 [4.0–10.0] 0.016* Opioid Consumption , yes ‡ 70 (77.8) 30 (100.0) 16 (53.3) 24 (80.0) < 0.001** Amount of Opioids ( mg ) § 200.0 [100.0–300.0] 200.0 [100.0–300.0] 100.0 [100.0–300.0] 200.0 [100.0–300.0] < 0.001* Postoperative Side Effects , present ‡ 35 (38.9) 15 (50.0) 10 (33.3) 10 (33.3) 0.311** Patient Satisfaction ‡ 1 1 (1.1) 0 (0.0) 0 (0.0) 1 (3.3) < 0.001** 2 6 (6.7) 3 (10.0) 2 (6.7) 1 (3.3) 3 43 (47.8) 20 (66.7) 5 (16.7) 18 (60.0) 4 32 (35.6) 7 (23.3) 18 (60.0) 7 (23.3) 5 8 (8.9) 0 (0.0) 5 (16.7) 3 (10.0) Physician Satisfaction ‡ 2 6 (6.7) 5 (16.7) 1 (3.3) 0 (0.0) <0.001** 3 33 (36.7) 16 (53.3) 5 (16.7) 12 (40.0) 4 32 (35.6) 8 (26.7) 10 (33.3) 14 (46.7) 5 19 (21.1) 1 (3.3) 14 (46.7) 4 (13.3) ESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane, VAS: Visual Analogue Scale, *. Kruskal–Wallis test. ** , Pearson’s Chi-Squared/Fisher–Freeman–Halton test, ‡ : n (%), § : Median [Min–Max] The number of patients with comorbid diseases was 12 (13.3%). The median and maximum VAS value was 3.7 and 6, respectively. Opioid use was necessary in 70 patients (77.8%), with a median opioid dose of 200 mg. Side effects associated with opioid use were observed in a total of 35 patients. There was no significant intergroup difference by the incidence of side effects associated with opioid use (p = 0.311). In terms of the patient satisfaction scores, 1 (1.1%) participant scored 1 point, 6 (6.7%) scored 2 points, 43 (47.8%) scored 3 points, 32 (35.6%) scored 4 points, and 8 (8.9%) scored 5 points. In terms of physician satisfaction, 6 (6.7%) participants scored 2 points, 33 (36.7%) scored 3 points, 32 (35.6%) scored 4 points and 19 (21.1%) scored 5 points. For group comparisons, there were significantly lower scores in the ESP group compared to the control group by mean value of VAS and maximum VAS value (p = 0.037, p = 0.016, respectively). The mean VAS value and maximum VAS value were lower in the TAP group compared to the control group. However, this difference was not significant (p < 0.05, p < 0.05, respectively). The comparison of intra-group and inter-group VAS scores over time is presented in Table 3 (In light of a significant intergroup difference at baseline [0 hours], delta values were derived by subtracting the 0-hour measurements from subsequent time points; these delta values were then subjected to further statistical analyses). Table 3 Comparison of VAS Scores Over Time Across Groups Group p* Control (n = 30) ESP (n = 30) TAP (n = 30) VAS 2 hours 1.0 [0.0–5.0] 1.0 [-3.0–4.0] 1.0 [-2.0–3.0] 0.047 α 4 hours 1.0 [-1.0–6.0] 1.0 [-2.0–4.0] 2.0 [-3.0–4.0] 0.019 α 8 hours 2.50.0 [0.0–6.0] 1.0 [-4.0–6.0] 2.0 [-2.0–6.0] 0.039 α 12 hours 4.0 [0.0–8.0] 2.0 [-2.0–6.0] 2.5 [-2.0–4.0] 0.001 α, § 24 hours 4.0 [0.0–9.0] 2.0 [-2.0–6.0] 3.0 [-1.0–5.0] 0.005 α p** <0.001 a,b,c,d <0.001 c,d,e < 0.001 b,c,d VAS: Visual Analogue Scale, ESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane, α : Control vs ESP, § : Control vs TAP, a : 2. Hours vs 8. Hours, b : 2. Hours vs 12. Hours, c : 2. Hours vs 24. Hours, d : 4. Hours vs 24. Hours, e : 8. Hours vs 24. Hours *Kruskal–Wallis H test., **Friedman test, Median [Min–Max] (Post-Hoc with Bonferroni correction), A comparison of median VAS values over time by groups is shown in Fig. 3 . There was also a significant intergroup difference by opioid use. ESP and TAP block treatments significantly reduced postoperative opioid consumption compared to the control group (p < 0.001, p < 0.001, respectively). Opioid use in the ESP group was significantly lower compared to the TAP group (p = 0.001). Postoperative opioid analgesic treatment was necessary in all patients in the control group, 53.3% in the ESP group, and 80% in the TAP group. Postoperative side effects associated with opioid use were observed in a total of 35 patients: 15 in the control group and 10 each in the ESP and TAP groups. This difference was not statistically significant (p = 0.311). However, when comparing the opioid doses used in patients with side effects to those without, the opioid use was significantly higher in the group with side effects (p = 0.026). Patient satisfaction was significantly higher in the ESP group compared to both the control and TAP groups (p 0.05). Advanced statistical analyses further confirmed that the ESP group exhibited significantly higher levels of patient satisfaction (p = 0.009). In terms of physician satisfaction, the ESP group demonstrated significantly higher scores compared to both the TAP and control groups (p < 0.001). No significant difference in satisfaction was observed between the TAP and control groups. Advanced statistical analyses identified maximum VAS scores, opioid dose, and patient satisfaction as significant factors influencing physician satisfaction, with each variable showing statistical significance (p < 0.05). Opioid use (r = − 0.472) and maximum VAS values (r = − 0.451) had a significant adverse effect on physician satisfaction, while patient satisfaction had a significant positive relationship (r = 364). Correlations between the opioid dose, physician and patient satisfaction, and clinical variables are summarized in Table 4 (The correlation coefficient, denoted as r, ranges from − 1 to + 1. A value of r close to -1 indicates a negative correlation between the variables, while a value close to + 1 suggests a positive correlation). Table 4 Correlations Between Clinical Variables and Opioid Consumption, Patient Satisfaction, and Physician Satisfaction Opioid (Milligram) Patient Satisfaction Physician Satisfaction r P r p r p VAS Median 0.364 0.002 -0.250 0.018 -0.359 < 0.001 VAS Max. 0.327 0.006 -0.266 0.011 -0.451 < 0.001 Age 0.179 0.139 -0.236 0.025 -0.195 0.066 BMI -0.004 0.973 0.108 0.311 0.015 0.886 ASA 0.033 0.788 0.007 0.951 0.174 0.100 Patient Satisfaction -0.213 0.077 Physician Satisfaction -0.472 < 0.001 0.364 < 0.001 - - Sex 0.075 0.539 0.113 0.290 0.124 0.246 Comorbid Conditions 0.028 0.815 0.054 0.613 0.066 0.538 Postoperative Side Effects -0.267 0.026 0.140 0.187 0.178 0.093 VAS: Visual Analogue Scale, BMI: Body Mass Index, ASA: American Society of Anesthesiologists, Spearman’s rho. 4. Discussion Postoperative surgical stress and pain induce the release of corticotropin-releasing hormone (CRH) from the hypothalamus, which in turn causes the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary lobe and ultimately cortisol from the adrenal cortex. These two factors also induce the release of vasopressin from the posterior pituitary. Another effect is on the sympathetic nervous system. By stimulating the sympathetic nervous system, it causes activation in the renin–angiotensin–aldosterone axis, leading to an increase in epinephrine and glucagon release, a decrease in insulin levels, and a decrease in renal blood flow [ 15 ]. All these neuroendocrine-metabolic responses and alterations in the hypothalamic–pituitary–adrenal axis result in immunosuppression. Regional anesthesia provides significant advantages for intraoperative management of the hypothalamic–pituitary–adrenal axis, including reduced stress response, better glycemic control, improved recovery, and potentially lower risks of chronic pain and recurrence of cancer [ 3 ]. These factors help regional anesthesia serve an appropriate choice in a variety of surgical contexts. The efficacy of ESP and TAP blocks in postoperative pain management was demonstrated in various previous studies and they were recommended for multimodal analgesia management [ 16 , 17 ]. The results of the present study on the reduction of postoperative opioid use using ESP and TAP blocks in patients, who underwent LSG, was largely consistent with the previous studies. There are recent studies in the relevant literature on the positive efficacy of the postoperative multimodal approach on analgesia management [ 18 , 19 ]. Yashraj Jain et al. suggested that the use of multimodal analgesia strategies in postoperative pain management was important to reduce opioid consumption and side effects [ 9 ]. Upon a literature review by Yuliana et al. on postoperative pain management, it was reported that appropriate management strategies could optimize pain relief and reduce side effects [ 20 ]. This strategy is consistent with the results of the present study that ESP and TAP blocks were effective in reducing opioid consumption. Elshazly et al. compared the feasibility and efficacy of ESP and TAP nerve blocks in patients undergoing bariatric surgery and reported statistically significant lower VAS scores in the ESP group at 30 min, 18 h, and 24 h after extubation [ 1 ]. Conversely, Saber et al. [ 21 ] and Wassef et al. [ 22 ] reported that TAP nerve blocks were not effective in reducing pain scores in LSG and bariatric surgery patients, respectively. In the present study, maximum and mean VAS values were significantly lower in the ESP group compared to the control group, while there was no statistically significant difference between the TAP and control groups. ESP nerve blocks may be more effective in pain management as they provide both visceral and somatic analgesia. The effectiveness of the TAP block in reducing VAS scores may have been limited, likely due to its selective blockade of somatic pain originating from the abdominal wall. Elshazly et al. also reported that the opioid requirements were significantly higher in patients who received TAP blocks compared to those who received ESP blocks [ 1 ]. Similarly, Altıparmak et al. compared TAP and ESP blocks in laparoscopic cholecystectomy and found that ESP blocks were more effective in reducing opioid use [ 23 ]. In this study, ESP and TAP block groups had significantly reduced postoperative opioid consumption compared to the control group, with the ESP group requiring less opioid than the TAP group. Postoperative opioid analgesic treatment was necessary for all patients in the control group, 53.3% in the ESP group, and 80% in the TAP group. Eadie et al. reported that regional anesthesia applications provided significant benefits to avoid the side effects of opioid use [ 24 ]. These results were consistent with a study by Bolesta et al. [ 25 ]. However, in this study, there were no significant intergroup differences by side effects. Notwithstanding above, the opioid dose used in 35 patients with side effects and 55 patients without side effects was significantly higher in favor of the group with side effects. Sinha and Mittal reported that patient satisfaction scores associated with analgesia were significantly higher in patients who underwent bariatric surgery and received TAP block compared to the control group [ 12 , 26 ]. The present study investigated both patient and physician satisfaction and found that ESP block application significantly increased the level of satisfaction compared to TAP and control groups. In conclusion, our study demonstrated that both ESP and TAP blocks are effective in reducing pain and opioid consumption following LSG. Notably, the ESP block was more effective in decreasing opioid requirements and postoperative VAS scores. This may be attributed to the blockade of both the dorsal and ventral branches of the spinal nerves by the ESP block, which provides analgesia to both the abdominal wall and internal organs, thus targeting both somatic and visceral pain. In comparison, TAP block application reduced postoperative opioid consumption and nearly significantly decreased VAS scores in our study relative to the control group. We hypothesize that with larger sample sizes in future studies, the reduction in VAS scores with TAP block may reach statistical significance. The lower effectiveness of the TAP block compared to the ESP block may be explained by the fact that the TAP block provides analgesia only to the abdominal wall. This study has certain limitations. First, the small sample size may limit the ability to generalize the results. Further studies with larger sample groups can help increase the accuracy and reliability of the results. Second, our study focused exclusively on patients who underwent LSG. Future research should investigate the efficacy of ESP and TAP blocks across a broader range of surgical procedures to enhance the generalizability of the findings. Such studies would offer valuable insights into the role of nerve blocks in diverse surgical contexts. Third, the study did not evaluate long-term outcomes. Long-term follow-up studies are necessary to better understand the impact of ESP and TAP nerve blocks on sustained pain management and potential long-term side effects. Furthermore, subjective measurements were used in our study. Individual differences and patient perceptions played an important role in the evaluation of subjective data such as pain and satisfaction. This is a factor that should be considered when interpreting the results. The time difference between the administration of the ESP block prior to anesthesia induction and the TAP block following induction may be considered another limitation of the study. 5. Conclusions The study found that VAS scores were significantly lower in the ESP group, and both ESP and TAP blocks significantly reduced postoperative opioid consumption. This reduction in pain and opioid use is important for preventing immunosuppression and minimizing-related side effects. Further comprehensive, large-scale studies are needed to confirm these findings and enhance clinical applications. Declarations Author Contributions: “Conceptualization, M.S.B. and H.E.; methodology, M.S.B. and H.Y.; validation, A.A., M.S.B. and H.E.; formal analysis, H.E. and H.Y.; investigation, M.S.B.; resources, A.A.; data curation, M.S.B., H.E.; writing—original draft preparation, M.S.B.; writing—review and editing, H.E., A.A. and H.Y.; All authors have read and agreed to the published version of the manuscript.” Funding: None Institutional Review Board Statement: Ethical approval for the study was obtained from the Ethics Committee of the Faculty of Medicine at Harran University, with the decision dated December 25, 2023, and numbered HRÜ/23.25.03. The study was carried out in accordance with the Declaration of Helsinki Principles. 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Sinha A, Jayaraman L, Punhani D. Efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic bariatric surgery: a double blind, randomized, controlled study. Obes Surg. 2013;23:548–53. https://doi.org/10.1007/s11695-012-0819-5 . Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41:621–7. https://doi.org/10.1097/AAP.0000000000000451 . Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med. 2017;42:372–6. https://doi.org/10.1097/AAP.0000000000000581 . Vicković S, Zdravković R, Maričić-Prijić S, Nikolić D, Pap D, Čolak E, et al. Salivary cortisol as a biomarker of stress in surgical patients. J Med Biochem. 2023;42:469–75. https://doi.org/10.5937/jomb0-42011 . Sia CJ, Wee S, Au-Yong AP, Lie SA, Tan WJ, Foo FJ, et al. Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis. Int J Surg. 2024;110:4393–401. https://doi.org/10.1097/JS9.0000000000001421 . Richards DC, Dunn BA, Chellappa VR, John CR, Davis WB. Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section. Int J Gynaecol Obstet. 2024;167:668–74. https://doi.org/10.1002/ijgo.15699 . Sia CJ, Wee S, Au-Yong AP, Lie SA, Tan WJ, Foo FJ, et al. Analgesia efficacy of erector spinae plane block in laparoscopic abdominal surgeries: a systemic review and meta-analysis. Int J Surg. 2024;110:4393–401. https://doi.org/10.1097/JS9.0000000000001421 . Földi M, Soós A, Hegyi P, Kiss S, Szakács Z, Solymár M, et al. Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials. Obes Surg. 2021;31:531–43. https://doi.org/10.1007/s11695-020-04973-8 . Yuliana Silitonga YA, Wahyuni A. Manajemen Nyeri Pasca Operasi: Tinjauan Pustaka. J Nutrient. 2022;2:27–37. https://doi.org/10.36911/nutrient.v2i2.1352 . Saber AA, Lee YC, Chandrasekaran A, Olivia N, Asarian A, Al-Ayoubi S, et al. Efficacy of transversus abdominis plane (TAP) block in pain management after laparoscopic sleeve gastrectomy (LSG): A double-blind randomized controlled trial. Am J Surg. 2019;217:126–32. https://doi.org/10.1016/j.amjsurg.2018.07.010 . Wassef M, Lee DY, Levine JL, Ross RE, Guend H, Vandepitte C, et al. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery. J Pain Res. 2013;6:837–41. https://doi.org/10.2147/JPR.S50561 . Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S. 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. J Clin Anesth. 2019;57:31–6. https://doi.org/10.1016/j.jclinane.2019.03.012 . Eadie R, McKenzie CA, Hadfield D, Kalk NJ, Bolesta S, Dempster M, et al. UK ALERT-ICU study investigators. Opioid, sedative, preadmission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study. Int J Clin Pharm. 2023;45:1167–75. https://doi.org/10.1007/s11096-023-01614-9 . Bolesta S, Burry L, Perreault MM, Gélinas C, Smith KE, Eadie R, et al. AduLt iatrogEnic withdRawal sTudy in the ICU (ALERT-ICU) Study Investigators. International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU. Crit Care Med. 2023;51:1502–14. https://doi.org/10.1097/CCM.0000000000005951 . Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc. 2018;32:4985–9. https://doi.org/10.1007/s00464-018-6261-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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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-5964286","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415339628,"identity":"044eeb7d-aeed-4f4c-a9fc-0dd3f05824a2","order_by":0,"name":"Mehmet Sait Berhuni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIie3PsWrCQBjA8Q8KTl+8TXKcNK/wiSCFSp/lDsHNEMjiE7hUdFV8iUAgawMFl0Y7yy19gA52y5ChuYiDkBi6dbj/cBzH/bjvAGy2/1hqFgIJgGYzltWpDFoJXclUQscQaiNwJfB+IXCHdPXH5JwHhc/EYS+C4NNn3qs6fxF4rJfWEn6cJXxJFPKVPxUb0iFfOLFbDjbY7mQtocxJAIlUlOFIIGkV7Z3IEEm6kcQ/RUneLuRoSJy3kEhUr2BFUkOSu6/wcjDRp2HoZjh8Rpqo7WKWPElyG//SNYN9F48+W+JAY/Gi1g+H+JTPxx4T9aQx92/XbTabzXbTLzvTWuPXnIPgAAAAAElFTkSuQmCC","orcid":"","institution":"Harran University","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"Sait","lastName":"Berhuni","suffix":""},{"id":415339629,"identity":"af607801-0abf-4c5c-86e6-e54eaaf9582e","order_by":1,"name":"Hasan Elkan","email":"","orcid":"","institution":"Harran University","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Elkan","suffix":""},{"id":415339630,"identity":"10d59b13-2457-4325-ad9e-fca435891a8c","order_by":2,"name":"Ahmet Atlas","email":"","orcid":"","institution":"Harran University","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"","lastName":"Atlas","suffix":""},{"id":415339631,"identity":"c908b82c-0ff4-4bcb-9339-f6fe51a4d111","order_by":3,"name":"Hüseyin Yönder","email":"","orcid":"","institution":"Harran University","correspondingAuthor":false,"prefix":"","firstName":"Hüseyin","middleName":"","lastName":"Yönder","suffix":""}],"badges":[],"createdAt":"2025-02-05 09:23:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5964286/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5964286/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76297574,"identity":"49ee515d-9da6-4de4-a5e0-49193f7d5aa7","added_by":"auto","created_at":"2025-02-14 13:27:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94748,"visible":true,"origin":"","legend":"\u003cp\u003eIdentifying the layers and determining the needle position in ESP Block application (T: Trapezius muscle, R: Rhomboid muscle, ES: Erector spina muscle, TP: Transverse process, PVS: Paravertebral space, area marked with an arrow: Needle insertion and drug administration)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5964286/v1/b054a1abd0b273169bf7c10b.png"},{"id":76298316,"identity":"cfc8e81d-3e40-45b8-a081-f917872354d5","added_by":"auto","created_at":"2025-02-14 13:35:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":144316,"visible":true,"origin":"","legend":"\u003cp\u003eIdentifying layers in the TAP Block application (EO: External oblique muscle, IO: Internal oblique muscle, TA: Transversus abdominis muscle)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5964286/v1/ea5a5eeff750c98419efb8fe.png"},{"id":76298315,"identity":"ac680516-4f49-425d-b847-f51c7ba97a73","added_by":"auto","created_at":"2025-02-14 13:35:44","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":43095,"visible":true,"origin":"","legend":"\u003cp\u003eTemporal Changes in Median VAS Scores Across Groups\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5964286/v1/6e1470580409354043459c3a.jpeg"},{"id":79162686,"identity":"01eaf0f0-f62d-41eb-b176-09c18b69c9ba","added_by":"auto","created_at":"2025-03-25 07:47:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5964286/v1/09bd3bc9-682c-4e0a-8e5b-7d9347e1b3e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The impact of regional anesthesia techniques on pain control and opioid consumption in sleeve gastrectomy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eObesity is a global health issue associated with significant morbidity and mortality due to its related comorbidities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery for managing obesity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFollowing tissue damage, local inflammatory mediators, such as bradykinin, substance P, prostaglandins, histamine, and serotonin, are released at the surgical site, inducing pain. Impulses from these inflammatory mediators upon tissue destruction activate nociceptors, i.e., free nerve endings that sense pain. Fast, sharp pain is transmitted by myelinated A-delta fibers, whereas slow, chronic pain is carried by unmyelinated C fibers via the spinal cord anterolateral pathway [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe perioperative period is characterized by immune system suppression for inflammatory pain and surgical stress, which inhibits cytotoxic cells [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Multimodal analgesia strategies during this period can benefit immune modulation and minimize immune suppression, thereby reducing postoperative morbidities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Regional anesthesia techniques as part of multimodal analgesia also modulate the immune response by reducing surgical stress and opioid use, which are known to impair cellular and humoral immunity. This helps protect patients from opioid-related side effects and prevents immunosuppression caused by pain and surgical stress. Effective management of immunosuppressive factors is crucial for shorter hospital stays, a more comfortable postoperative process, and reduced hospital costs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePostoperative pain management can be complicated by serious side effects, such as respiratory depression, cardiopulmonary arrest, cardiopulmonary arrest, urinary retention, ileus, and addictive potential, of high-dose opioids used for analgesia in patients who undergo bariatric surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Opioids also suppress the immune system by weakening the cytotoxic functions of natural killer cells [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, it is important to minimize the use of opioids and to investigate alternative pain management methods to opioids or can be used in combination with opioids [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Visual analog scale (VAS) is a reliable and valid scale for assessing pain severity in postoperative patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transversus abdominis plane (TAP) block, first described by Rafi in 2001, is an intervention that creates a peripheral nerve block in the anterolateral abdominal wall [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. TAP is the space between the internal oblique muscle and the transversus abdominis muscles. An anesthetic is injected into this site for the procedure. Initially, the procedure was performed blindly, but its reliability and success rate have improved with ultrasonography (USG) guidance [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The erector spinae plane (ESP) block, introduced as a technique for managing thoracic neuropathic pain and pain associated with thoracic trauma or surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], is based on the columnar arrangement of the erector spinae muscle and retinaculum. This concept suggests that ESP block applications at lower thoracic levels might also provide abdominal analgesia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study aimed to compare the efficacy of ESP and TAP blocks in reducing the need for postoperative analgesia and opioid use in patients undergoing SG.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e \u003cb\u003eStudy Design and Patient Population\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The study was reviewed and approved by the Harran University Clinical Research Ethics Committee (28.12.2023-25).\u003c/p\u003e \u003cp\u003eThe study was designed as a retrospective study. The patients included in the study were selected from those who underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity in our clinic between January 1, 2023, and June 30, 2023. The patients were equally allocated into three groups\u0026mdash;ESP block, TAP block, and control (no regional anesthesia applied)\u0026mdash;with 30 patients in each group. During the allocation process, patients were matched for age and gender.\u003c/p\u003e \u003cp\u003eAll patients underwent LSG by a single general surgeon. Due to the potential need for analgesics in the postoperative recovery unit, the patients were accompanied by the anesthesiologist, who performed the block procedure. Postoperative pain assessment was performed using VAS score at 0, 2, 4, 8, 12, and 24 h after the patient was returned to their room.\u003c/p\u003e \u003cp\u003eA Likert type survey was used to assess patient and physician satisfaction with postoperative analgesia. This survey is a routine assessment tool applied to patients who have undergone obesity surgery during their outpatient follow-up visits in our clinic. During the first outpatient clinic control after discharge, the patient was asked, \u0026ldquo;Considering the pain I experienced after surgery, I would have surgery again if I went back to the preoperative period\u0026rdquo;; and the physician was asked, \u0026ldquo;When I evaluate the patient in terms of pain control, the patient was easy to manage.\u0026rdquo; They were asked to respond both questions with one of the following answers and scored thereafter;\u003c/p\u003e \u003cp\u003eStrongly disagree (1 point)\u003c/p\u003e \u003cp\u003eDisagree (2 points)\u003c/p\u003e \u003cp\u003eNeither agree nor disagree (3 points)\u003c/p\u003e \u003cp\u003eAgree (4 points)\u003c/p\u003e \u003cp\u003eStrongly agree (5 points)\u003c/p\u003e \u003cp\u003ePatients were evaluated by age, sex, body mass index (BMI), American Society of Anesthesiologists physical status classifications (ASA) score, comorbidity, amount of opioid use, VAS score, side effects (urinary retention, cardiopulmonary arrest, respiratory depression and ileus were considered as side effects), patient, and physician satisfaction. Data other than the survey responses were obtained from patient records.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and Exclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePursuant to the inclusion criteria, patients aged 18\u0026ndash;60 years, patients with ASA scores of I, II, and III, and a BMI of \u0026gt;\u0026thinsp;35 kg/m2 were included in the study.\u003c/p\u003e \u003cp\u003eFor the exclusion criteria, patients with missing data in their records, patients who were allergic to local anesthetics, refused a regional block, underwent concomitant surgeries, experienced intraoperative or postoperative complications within the first 24 h, had a platelet count of \u0026lt;\u0026thinsp;100,000, had known coagulopathy, or had a history of opioid addiction. Patients who underwent concomitant surgeries (e.g., cholecystectomy) were excluded from the study due to the potential for increased surgical morbidity and higher analgesic requirements. Additionally, patients with coagulopathy or low platelet counts were excluded due to the elevated risk of bleeding, and individuals with opioid dependence were excluded as they may require higher opioid doses for effective analgesia.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGeneral Anesthesia, ESP, and TAP Block Applications\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAt induction of anesthesia, all patients received 2 mg/kg propofol, 0.5 mg/kg atracurium, and 2 mcg/kg fentanyl based on their corrected ideal weight. No additional analgesics or anti-inflammatories were administered. For preoperative antibiotic prophylaxis, 1000 mg of 1st generation cephalosporin was administered intravenously. Regional anesthesia was performed by the same anesthesiologist to ensure consistency in the study results. All regional anesthesia procedures were performed on the operating table upon induction of anesthesia. The control group did not receive regional anesthesia. Intravenous (IV) opioids were used for postoperative analgesia in all groups based on the patient\u0026rsquo;s needs and VAS scores.\u003c/p\u003e \u003cp\u003e \u003cb\u003eESP Block Application\u003c/b\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eESP block was performed immediately after induction of anesthesia to investigate its effect on postoperative analgesia. It was performed on the operating table prior to induction of general anesthesia. Overall, 10% povidone\u0026ndash;iodine was used for skin preparation. The probe was covered with a sterile drape. All ESP blocks were performed by the same anesthesiologist, who was experienced in ultrasound-guided regional anesthesia techniques. A wide-bandwidth (1\u0026ndash;8 MHz) convex probe (Esaote\u0026reg;, MyLab5, Italy) and a 22G, 50 or 100 mm, isolated facet-type needle (Braun Sonoplex, Melsungen, Germany) were used to perform the multifrequency block. Blocks were performed bilaterally using an intraplane approach at the T8 level with the patient in the prone position. The convex probe was placed 2\u0026ndash;3 cm lateral to the spine using a sagittal approach. The needle was inserted deeply into the erector spinae muscle after the erector spinae muscle and transverse processes were identified (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The correct position of the needle tip was verified by 0.5\u0026ndash;1 ml of local anesthetic (LA). 20 ml of 0.25% bupivacaine was administered as local anesthetic to perform the ESP block. local anesthetic spread was confirmed in both cranial and caudal directions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTAP Block Procedure\u003c/b\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFollowing the induction of general anesthesia, the surgical site was cleaned with an antiseptic solution on the operating table and a sterile cover was placed over the linear ultrasound probe (Esaote\u0026reg;, MyLab5, Italy). To capture the optimal image, the probe was moved vertically or tilted up and down along the abdominal wall toward the costal margin and iliac crest. The probe was secured in position once it obtained a clear view, spanning from the superficial to deep layers and displaying the skin, subcutaneous fat tissue, external oblique muscle, internal oblique muscle, transversus abdominis muscle fascia, and peritoneum. A 100-mm, 22-G needle (Braun Sonoplex, Melsungen, Germany) was advanced anterior to posterior using an in-plane technique under ultrasound guidance. To confirm proper placement of the needle tip between the fascial planes of the internal oblique and transversus abdominis muscles, careful aspiration was performed. Subsequently, a test dose of 1 mL of 0.25% bupivacaine was administered to confirm proper needle localization (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Following this, 20 mL of 0.25% bupivacaine solution was injected simultaneously on both the right and left sides under ultrasound guidance, after which the surgical procedure was initiated.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll patients underwent LSG, performed by a single general surgeon. Following surgery, the anesthesiologist who performed the block procedure accompanied the patients in the post-anesthesia care unit to address any potential analgesic needs. Once the patient was transferred to the regular ward, pain assessments were conducted based on the VAS score at 0, 2, 4, 8, 12, and 24 hours after surgery.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using SPSS for Windows, version 25.0 (IBM SPSS Inc., Chicago, IL, USA). The Shapiro\u0026ndash;Wilk test was employed to assess the normality of the data distribution. As the data did not follow a normal distribution, continuous variables are presented as medians and minimum-maximum, while categorical variables are reported as counts (n) and percentages (%). Between-group comparisons involving more than two independent groups were conducted using the Kruskal\u0026ndash;Wallis H test. To evaluate changes in intragroup VAS scores over time (at 2, 4, 8, 12, and 24 hours), the Friedman test was applied, followed by post-hoc pairwise comparisons with Bonferroni correction. The Chi-square test was used for the analysis of categorical variables. All analyses were performed using a 95% confidence interval, and a two-tailed p-value less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study including 25 (27.8%) male and 65 (72.2%) female patients. The mean age of the patients was 33.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 years, where the mean BMI was 46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 kg/m\u0026sup2;. Overall 46 (51.1%) patients were classified as ASA 2 and 44 (48.9%) as ASA 3. There were no significant intergroup differences by age, sex, BMI, ASA score, and comorbidity variables (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for each) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\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\u003eComparison of Clinical and Demographic Characteristics based on Postoperative Analgesia Methods\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=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eESP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eTAP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.054*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.679**\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\u003e65 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (76.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (73.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.992*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA Score\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.252**\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\u003e44 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (36.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbid Conditions\u003c/b\u003e, \u003cem\u003epresent\u003c/em\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.999**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane, BMI: Body Mass Index, ASA: American Society of Anesthesiologists\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*.\u003c/b\u003e One-way ANOVA. \u003cb\u003e**.\u003c/b\u003e Pearson\u0026rsquo;s Chi-Squared/Fisher\u0026ndash;Freeman\u0026ndash;Halton test, \u003cb\u003e\u0026Dagger;\u003c/b\u003e: n (%), \u003cb\u003e\u0026dagger;\u003c/b\u003e: Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThere were significant differences between the groups by mean and maximum VAS scores, opioid use, patient, and physician satisfaction (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\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\u003eComparison of VAS Scores, Opioid Use and Satisfaction based on Postoperative Analgesia Methods\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eESP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eTAP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS Median\u003c/b\u003e \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.7 [0.3\u0026ndash;7.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3 [1.3\u0026ndash;6.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2 [0.3\u0026ndash;5.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.9 [2.2\u0026ndash;7.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS Max.\u003c/b\u003e \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.0 [2.0\u0026ndash;10.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.0 [2.0\u0026ndash;10.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0 [2.0\u0026ndash;9.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.0 [4.0\u0026ndash;10.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOpioid Consumption\u003c/b\u003e, \u003cem\u003eyes\u003c/em\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmount of Opioids (\u003cem\u003emg\u003c/em\u003e) \u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200.0 [100.0\u0026ndash;300.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200.0 [100.0\u0026ndash;300.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0 [100.0\u0026ndash;300.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e200.0 [100.0\u0026ndash;300.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Side Effects\u003c/b\u003e, \u003cem\u003epresent\u003c/em\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.311**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Satisfaction\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (3.3)\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (23.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysician Satisfaction\u003c/b\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;0.001**\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14 (46.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane, VAS: Visual Analogue Scale,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*.\u003c/b\u003e Kruskal\u0026ndash;Wallis test. \u003cb\u003e**\u003c/b\u003e, Pearson\u0026rsquo;s Chi-Squared/Fisher\u0026ndash;Freeman\u0026ndash;Halton test, \u003cb\u003e\u0026Dagger;\u003c/b\u003e: n (%), \u003cb\u003e\u0026sect;\u003c/b\u003e: Median [Min\u0026ndash;Max]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe number of patients with comorbid diseases was 12 (13.3%). The median and maximum VAS value was 3.7 and 6, respectively. Opioid use was necessary in 70 patients (77.8%), with a median opioid dose of 200 mg. Side effects associated with opioid use were observed in a total of 35 patients. There was no significant intergroup difference by the incidence of side effects associated with opioid use (p\u0026thinsp;=\u0026thinsp;0.311). In terms of the patient satisfaction scores, 1 (1.1%) participant scored 1 point, 6 (6.7%) scored 2 points, 43 (47.8%) scored 3 points, 32 (35.6%) scored 4 points, and 8 (8.9%) scored 5 points. In terms of physician satisfaction, 6 (6.7%) participants scored 2 points, 33 (36.7%) scored 3 points, 32 (35.6%) scored 4 points and 19 (21.1%) scored 5 points.\u003c/p\u003e \u003cp\u003eFor group comparisons, there were significantly lower scores in the ESP group compared to the control group by mean value of VAS and maximum VAS value (p\u0026thinsp;=\u0026thinsp;0.037, p\u0026thinsp;=\u0026thinsp;0.016, respectively). The mean VAS value and maximum VAS value were lower in the TAP group compared to the control group. However, this difference was not significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively). The comparison of intra-group and inter-group VAS scores over time is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (In light of a significant intergroup difference at baseline [0 hours], delta values were derived by subtracting the 0-hour measurements from subsequent time points; these delta values were then subjected to further statistical analyses).\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\u003eComparison of VAS Scores Over Time Across Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eESP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTAP\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 [0.0\u0026ndash;5.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 [-3.0\u0026ndash;4.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 [-2.0\u0026ndash;3.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.047 \u003csup\u003e\u003cb\u003eα\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 [-1.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 [-2.0\u0026ndash;4.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0 [-3.0\u0026ndash;4.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019 \u003csup\u003e\u003cb\u003eα\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50.0 [0.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 [-4.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0 [-2.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039 \u003csup\u003e\u003cb\u003eα\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 [0.0\u0026ndash;8.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0 [-2.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5 [-2.0\u0026ndash;4.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001 \u003csup\u003e\u003cb\u003eα, \u0026sect;\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 [0.0\u0026ndash;9.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0 [-2.0\u0026ndash;6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0 [-1.0\u0026ndash;5.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005 \u003csup\u003e\u003cb\u003eα\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e \u003csup\u003e\u003cb\u003ea,b,c,d\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e \u003csup\u003e\u003cb\u003ec,d,e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u0026nbsp;\u003csup\u003e\u003cb\u003eb,c,d\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eVAS: Visual Analogue Scale, ESP: Erector Spinae Plane, TAP: Transversus Abdominis Plane,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eα\u003c/b\u003e: Control vs ESP, \u003cb\u003e\u0026sect;\u003c/b\u003e: Control vs TAP, \u003cb\u003ea\u003c/b\u003e: 2. Hours vs 8. Hours, \u003cb\u003eb\u003c/b\u003e: 2. Hours vs 12. Hours, \u003cb\u003ec\u003c/b\u003e: 2. Hours vs 24. Hours, \u003cb\u003ed\u003c/b\u003e: 4. Hours vs 24. Hours, \u003cb\u003ee\u003c/b\u003e: 8. Hours vs 24. Hours\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Kruskal\u0026ndash;Wallis H test., **Friedman test, Median [Min\u0026ndash;Max] (Post-Hoc with Bonferroni correction),\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA comparison of median VAS values over time by groups is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThere was also a significant intergroup difference by opioid use. ESP and TAP block treatments significantly reduced postoperative opioid consumption compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). Opioid use in the ESP group was significantly lower compared to the TAP group (p\u0026thinsp;=\u0026thinsp;0.001). Postoperative opioid analgesic treatment was necessary in all patients in the control group, 53.3% in the ESP group, and 80% in the TAP group.\u003c/p\u003e \u003cp\u003ePostoperative side effects associated with opioid use were observed in a total of 35 patients: 15 in the control group and 10 each in the ESP and TAP groups. This difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.311). However, when comparing the opioid doses used in patients with side effects to those without, the opioid use was significantly higher in the group with side effects (p\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e \u003cp\u003ePatient satisfaction was significantly higher in the ESP group compared to both the control and TAP groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, patient satisfaction in the ESP group increased by 58% (p\u0026thinsp;=\u0026thinsp;0.009). No significant difference in patient satisfaction was observed between the TAP and control groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Advanced statistical analyses further confirmed that the ESP group exhibited significantly higher levels of patient satisfaction (p\u0026thinsp;=\u0026thinsp;0.009). In terms of physician satisfaction, the ESP group demonstrated significantly higher scores compared to both the TAP and control groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant difference in satisfaction was observed between the TAP and control groups. Advanced statistical analyses identified maximum VAS scores, opioid dose, and patient satisfaction as significant factors influencing physician satisfaction, with each variable showing statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Opioid use (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.472) and maximum VAS values (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.451) had a significant adverse effect on physician satisfaction, while patient satisfaction had a significant positive relationship (r\u0026thinsp;=\u0026thinsp;364). Correlations between the opioid dose, physician and patient satisfaction, and clinical variables are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e (The correlation coefficient, denoted as r, ranges from \u0026minus;\u0026thinsp;1 to +\u0026thinsp;1. A value of r close to -1 indicates a negative correlation between the variables, while a value close to +\u0026thinsp;1 suggests a positive correlation).\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\u003eCorrelations Between Clinical Variables and Opioid Consumption, Patient Satisfaction, and Physician Satisfaction\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOpioid (Milligram)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePatient Satisfaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePhysician Satisfaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS Median\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS Max.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysician Satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbid Conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Side Effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVAS: Visual Analogue Scale, BMI: Body Mass Index, ASA: American Society of Anesthesiologists, Spearman\u0026rsquo;s rho.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003ePostoperative surgical stress and pain induce the release of corticotropin-releasing hormone (CRH) from the hypothalamus, which in turn causes the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary lobe and ultimately cortisol from the adrenal cortex. These two factors also induce the release of vasopressin from the posterior pituitary. Another effect is on the sympathetic nervous system. By stimulating the sympathetic nervous system, it causes activation in the renin\u0026ndash;angiotensin\u0026ndash;aldosterone axis, leading to an increase in epinephrine and glucagon release, a decrease in insulin levels, and a decrease in renal blood flow [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. All these neuroendocrine-metabolic responses and alterations in the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal axis result in immunosuppression. Regional anesthesia provides significant advantages for intraoperative management of the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal axis, including reduced stress response, better glycemic control, improved recovery, and potentially lower risks of chronic pain and recurrence of cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These factors help regional anesthesia serve an appropriate choice in a variety of surgical contexts.\u003c/p\u003e \u003cp\u003eThe efficacy of ESP and TAP blocks in postoperative pain management was demonstrated in various previous studies and they were recommended for multimodal analgesia management [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The results of the present study on the reduction of postoperative opioid use using ESP and TAP blocks in patients, who underwent LSG, was largely consistent with the previous studies.\u003c/p\u003e \u003cp\u003eThere are recent studies in the relevant literature on the positive efficacy of the postoperative multimodal approach on analgesia management [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Yashraj Jain et al. suggested that the use of multimodal analgesia strategies in postoperative pain management was important to reduce opioid consumption and side effects [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Upon a literature review by Yuliana et al. on postoperative pain management, it was reported that appropriate management strategies could optimize pain relief and reduce side effects [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This strategy is consistent with the results of the present study that ESP and TAP blocks were effective in reducing opioid consumption.\u003c/p\u003e \u003cp\u003eElshazly et al. compared the feasibility and efficacy of ESP and TAP nerve blocks in patients undergoing bariatric surgery and reported statistically significant lower VAS scores in the ESP group at 30 min, 18 h, and 24 h after extubation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Conversely, Saber et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Wassef et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reported that TAP nerve blocks were not effective in reducing pain scores in LSG and bariatric surgery patients, respectively. In the present study, maximum and mean VAS values were significantly lower in the ESP group compared to the control group, while there was no statistically significant difference between the TAP and control groups. ESP nerve blocks may be more effective in pain management as they provide both visceral and somatic analgesia. The effectiveness of the TAP block in reducing VAS scores may have been limited, likely due to its selective blockade of somatic pain originating from the abdominal wall.\u003c/p\u003e \u003cp\u003eElshazly et al. also reported that the opioid requirements were significantly higher in patients who received TAP blocks compared to those who received ESP blocks [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Similarly, Altıparmak et al. compared TAP and ESP blocks in laparoscopic cholecystectomy and found that ESP blocks were more effective in reducing opioid use [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, ESP and TAP block groups had significantly reduced postoperative opioid consumption compared to the control group, with the ESP group requiring less opioid than the TAP group. Postoperative opioid analgesic treatment was necessary for all patients in the control group, 53.3% in the ESP group, and 80% in the TAP group.\u003c/p\u003e \u003cp\u003eEadie et al. reported that regional anesthesia applications provided significant benefits to avoid the side effects of opioid use [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These results were consistent with a study by Bolesta et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, in this study, there were no significant intergroup differences by side effects. Notwithstanding above, the opioid dose used in 35 patients with side effects and 55 patients without side effects was significantly higher in favor of the group with side effects.\u003c/p\u003e \u003cp\u003eSinha and Mittal reported that patient satisfaction scores associated with analgesia were significantly higher in patients who underwent bariatric surgery and received TAP block compared to the control group [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The present study investigated both patient and physician satisfaction and found that ESP block application significantly increased the level of satisfaction compared to TAP and control groups.\u003c/p\u003e \u003cp\u003eIn conclusion, our study demonstrated that both ESP and TAP blocks are effective in reducing pain and opioid consumption following LSG. Notably, the ESP block was more effective in decreasing opioid requirements and postoperative VAS scores. This may be attributed to the blockade of both the dorsal and ventral branches of the spinal nerves by the ESP block, which provides analgesia to both the abdominal wall and internal organs, thus targeting both somatic and visceral pain. In comparison, TAP block application reduced postoperative opioid consumption and nearly significantly decreased VAS scores in our study relative to the control group. We hypothesize that with larger sample sizes in future studies, the reduction in VAS scores with TAP block may reach statistical significance. The lower effectiveness of the TAP block compared to the ESP block may be explained by the fact that the TAP block provides analgesia only to the abdominal wall.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. First, the small sample size may limit the ability to generalize the results. Further studies with larger sample groups can help increase the accuracy and reliability of the results. Second, our study focused exclusively on patients who underwent LSG. Future research should investigate the efficacy of ESP and TAP blocks across a broader range of surgical procedures to enhance the generalizability of the findings. Such studies would offer valuable insights into the role of nerve blocks in diverse surgical contexts. Third, the study did not evaluate long-term outcomes. Long-term follow-up studies are necessary to better understand the impact of ESP and TAP nerve blocks on sustained pain management and potential long-term side effects.\u003c/p\u003e \u003cp\u003eFurthermore, subjective measurements were used in our study. Individual differences and patient perceptions played an important role in the evaluation of subjective data such as pain and satisfaction. This is a factor that should be considered when interpreting the results. The time difference between the administration of the ESP block prior to anesthesia induction and the TAP block following induction may be considered another limitation of the study.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe study found that VAS scores were significantly lower in the ESP group, and both ESP and TAP blocks significantly reduced postoperative opioid consumption. This reduction in pain and opioid use is important for preventing immunosuppression and minimizing-related side effects. Further comprehensive, large-scale studies are needed to confirm these findings and enhance clinical applications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e \u0026ldquo;Conceptualization, M.S.B. and H.E.; methodology, M.S.B. and H.Y.; validation, A.A., M.S.B. and H.E.; formal analysis, H.E. and H.Y.; investigation, M.S.B.; resources, A.A.; data curation, M.S.B., H.E.; writing\u0026mdash;original draft preparation, M.S.B.; writing\u0026mdash;review and editing, H.E., A.A. and H.Y.; All authors have read and agreed to the published version of the manuscript.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eEthical approval for the study was obtained from the Ethics Committee of the Faculty of Medicine at Harran University, with the decision dated December 25, 2023, and numbered HR\u0026Uuml;/23.25.03. The study was carried out in accordance with the Declaration of Helsinki Principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individuals included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e We declare that no new data is created.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflict of interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eElshazly M, El-Halafawy YM, Mohamed DZ, Wahab KAE, Mohamed TMK. Feasibility and efficacy of erector spinae plane block versus transversus abdominis plane block in laparoscopic bariatric surgery: a randomized comparative trial. 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Surg Endosc. 2018;32:4985\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00464-018-6261-6\u003c/span\u003e\u003cspan address=\"10.1007/s00464-018-6261-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Erector spinae plane block, laparoscopic sleeve gastrectomy, opioid consumption, postoperative pain, transversus abdominis plane block","lastPublishedDoi":"10.21203/rs.3.rs-5964286/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5964286/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aims to evaluate the effectiveness of erector spinae block (ESP) and transversus abdominis plane (TAP) blocks in reducing postoperative opioid requirements and enhancing pain control in laparoscopic sleeve gastrectomy (LSG) patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospektif study included 90 patients undergoing LSG. The patients were equally allocated into three groups\u0026mdash;ESP block, TAP block, and control (no regional anesthesia applied)\u0026mdash;with 30 patients in each group. During the allocation process, patients were matched for age and gender. Pain levels were assessed using the Visual Analog Scale (VAS) at 0, 2, 4, 8, 12, and 24 hours postoperatively. Opioid consumption, side effect, patient and surgeon satisfaction were recorded. Statistical analyses were conducted to compare pain scores, opioid use, and satisfaction levels among the groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eESP group demonstrated significantly lower VAS scores compared to the control group. The ESP block group reported the lowest VAS scores, indicating superior pain control. Opioid consumption was significantly reduced in both ESP and TAP block groups compared to the control group, with the ESP group showing the greatest reduction. There was a significant relationship between amount of opioid used and side effects. Patient satisfaction was highest in the ESP block group, followed by the TAP block group, and lowest in the control group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe ESP and TAP blocks are effective in reducing postoperative opioid consumption and providing better pain control in LSG patients. The ESP block, in particular, offers superior analgesia and higher patient satisfaction compared to the TAP block and no block.\u003c/p\u003e","manuscriptTitle":"The impact of regional anesthesia techniques on pain control and opioid consumption in sleeve gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 13:27:39","doi":"10.21203/rs.3.rs-5964286/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d03a7ee3-d541-4400-9d1e-32bf3c01e4f9","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-25T07:39:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 13:27:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5964286","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5964286","identity":"rs-5964286","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}