Comparison of the Effects of External Oblique Intercostal Plane Block and Subcostal Transversus Plane Block Methods With Ultrasound Guidance on Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy Operations

Obesity is a global health problem currently treated with diet, pharmacotherapy, and bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure that often results in moderate to severe postoperative pain. Adequate pain control after LSG is crucial for early mobilization and prevention of complications . As a relatively novel technique, the external oblique intercostal block (EOIB) provides analgesia for anterolateral upper abdominal surgery by blocking both the lateral and anterior cutaneous branches of the intercostal nerves between T6-7 and T10-11 . The subcostal transversus abdominis plane (s-TAP) block provides sensory blockade over nearly the entire anterior abdominal wall between T6 and T9. Therefore, it can be considered as part of multimodal analgesia for both laparotomy and laparoscopic abdominal surgical procedures.

The primary aim of this study was to investigate the effects of the external oblique intercostal block (EOIB) and the subcostal transversus abdominis plane (s-TAP) block on postoperative pain scores and opioid consumption in patients undergoing laparoscopic sleeve gastrectomy.

• Ultrasound-guided external oblique intercostal plane block (Procedure): Ultrasound-guided external oblique intercostal plane block will be performed at the T6 level using 20 ml of 0.25% bupivacaine at the Immediately after intubation
• Local anesthetic infiltration (Procedure): Port-site local anesthetic infiltration will be performed with bupivacain after intubation by surgeon.
• Subcostal Transversus Abdominis Plane Block (s-TAP) (Procedure): Ultrasound-guided OSTAP block will be performed using 20 ml of 0.25% bupivacaine immediately after intubation.

Primary outcomes

• Postoperative Acute Pain Scores [postoperative T1: 0. hours, T2:4.hours,T3:12.hours,T4: 24.hours]: Postoperative acute pain scores assingment with Visual Analog Scores

Secondary outcomes

• Total Opioid Consumption [POSTOPERATİVE T1:0 HOURS T2:4. HOURS T3:12.HOURS T4:24.HOURS]: We plan to investigate the effects of the external oblique intercostal block and the subcostal transversus abdominis plane block onopioid consumption in patients undergoing laparoscopic sleeve gastrectomy after surgery.
• PATIENT SATISFACTION (Likert Scale) Not satisfied at all 1 Slightly satisfied 2 Moderately satisfied3 Satisfied4 Excellent5 SURGEON SATISFACTION (Likert Scale) Not satisfied at all 1 Slightly satisfied 2 Moderately satisfied3 Satisfied4 Excellent5 [Postoperative 24.hours]: Secondary outcomes will include patient- and surgeon-based Likert scale assessments.
• Postoperative Nause and Vomiting [Postoperative first 24.hours]

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

* Adult patients aged between 18 and 65 years
* Patients classified as American Society of Anesthesiologists (ASA) physical status I-III

Exclusion Criteria:

* Patients younger than 18 years or older than 65 years
* Inability to cooperate or comply with study procedures
* Liver and kidney failure
* American Society of Anesthesiologists (ASA) IV-V patient
* External oblique intercostal block(EOİB) and the Subcostal Transversus Abdominis Plane block(s-TAB) are contraindicated

• Melike Bostancı Erkmen, M.D., Principal investigator, Sanliurfa Education and Research Hospital
• Tolga Karaçay, M.D., Principal investigator, Sanliurfa Education and Research Hospital
• Servet Sürmeli, M.D., Principal investigator, Sanliurfa Education and Research Hospital