The goal of this clinical trial is to learn which is better, combining Dexmedetomidine infusion and paragastric neural block or combining laparoscopic TAP block and paragastric neural block to enhance recovery after laparoscopic sleeve gastrectomy.
The main questions it aims to answer are:
Will using paragastric neural block (PGNB) combined with dexmedetomidine infusion give better recovery or using PGNB combined with laparoscopic transversus abdominis plane (LTAP) block in patients undergoing laparoscopic sleeve gastrectomy.
This will be assessed by:
Recording how much opioids were consumed by the patients Hemodynamic stability of the enrolled patients Pain scores as given by the patient The quality of postoperative patient recovery How many patients encountered nausea or vomiting
American Society of Anesthesiologists (ASA) physical status II- III
BMI 35- 50 kg/m2
Significant hepatic, renal, neuromuscular, or cardiac impairments
Extreme obesity (BMI > 50 kg/m2)
Patients on current opioid medication
Allergies to dexmedetomidine or bupivacaine
Parallel
Dexmedetomidine infusion
DrugDexmedetomidine will be maintained at 0.5 μg/kg/h ideal body weight via a syringe pump until trocar removal.
Paragastric neural block
Procedure/SurgeryParagastric neural block (PGNB) will be administered using a 25-gauge needle attached to a venous catheter extension, introduced through the left 12 mm port. Infiltration of 20 mL undiluted 0.5% bupivacaine will be performed at six levels in the fatty tissue of the paragastric area, including the lesser omentum, vagus nerve, esophago-gastric junction, proximal stomach, mid-stomach, distal antrum, hepatic artery, and left gastric artery, with the needle cap removed under direct vision throughout the procedure.
Laparoscopic Transversus Abdominis Plane (LTAP) block
Procedure/SurgeryLTAP will be administered after insufflation before insertion of the right and left-handed ports. 30 mL of 0.25% bupivacaine will be injected into the posterolateral subcostal regions on both sides. The correct placement will be confirmed by observing the spread of fluid between the transversus abdominis and the internal oblique muscle layers laparoscopically
Opioid Consumption
Total opioids consumed by the patient will be recorded
Patient satisfaction using the QoR 40 questionnaire
Patient satisfaction with the procedure done will be measured using the QoR (quality of recovery)40 questionnaire. Scores range from 40 (extremely poor quality of recovery) to 200 (excellent quality of recovery)
Heart Rate
Heart rate (beats/min) will be monitored continuously every 5 minutes and will be recorded prior to induction, post-induction, after the loading dose of dexmedetomidine, 4 hours and 12 hours postoperatively.
Time to mobilize
The time to which the patient will be able to start mobilization after surgery will be recorded (in minutes)
Incidence of nausea and vomiting
The incidence of nausea and vomiting after surgery will be recorded
Baseline demographics
Age, sex, body mass index (BMI), and comorbidities will be recorded
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