Pain management for laparoscopic sleeve gastrectomy

BACKGROUND: Bariatric surgery, particularly laparoscopic sleeve gastrectomy, is an effective and pivotal treatment for obesity. Patients undergoing laparoscopic sleeve gastrectomy commonly experience moderate pain in the immediate postoperative period. Therefore, optimal pain management is crucial. OBJECTIVE: The aim of this review was to update the recommendations for pain management following laparoscopic sleeve gastrectomy, building upon the 2019 guidelines. DESIGN: A systematic review was conducted using the PROSPECT methodology. DATA SOURCES: Randomised controlled clinical trials (RCTs) and systematic reviews concerning analgesic, anaesthetic and operative interventions, focusing on pain management for patients undergoing laparoscopic sleeve gastrectomy, were identified through searches in MEDLINE, EMBASE and Cochrane Databases from September 2018 until February 2024. Primary outcome included pain scores. We used the Rob 2 tool as our method to assess the risk of bias in the included studies. RESULTS: The previous review included data from 18 RCTs. Since then, 188 eligible studies were identified, of which 39 RCTs and two meta-analyses met our inclusion criteria. In addition to paracetamol and NSAIDs or cyclooxygenase (COX)-2 specific inhibitors, ultrasound or laparoscopic-guided bilateral transversus abdominis plane (TAP) blocks and port-site local anaesthetic infiltration are recommended. In addition, intra-operative intravenous dexamethasone is recommended for analgesia and prevention of postoperative nausea and vomiting. Opioids are reserved for rescue treatment. CONCLUSIONS: This systematic review identified an evidence-based analgesic regimen for laparoscopic sleeve gastrectomy. Our current recommendations differ from the previous ones in that a TAP block is now recommended, and gabapentinoids are no longer advised. PROSPERO REGISTRATION NUMBER: CRD42023487108.