Intraoperative Paragastric Vagal Nerve Block With Ropivacaine Reduces Postoperative Nausea and Pain on the Day of Surgery After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study With Propensity Score Matching.

BACKGROUND

Postoperative nausea and visceral gastric pain are major early complications after laparoscopic sleeve gastrectomy (LSG). We evaluated whether intraoperative paragastric infiltration of ropivacaine targeting the anterior vagal trunk reduces postoperative antiemetic and analgesic requirements.

METHODS

This retrospective cohort study compared patients who underwent LSG with paragastric vagal nerve block (VNB group; 0.375% ropivacaine 20 mL; n = 123) against a historical control group (n = 159). Propensity score matching (PSM) on sex, BMI, age, and operative time yielded 92 matched pairs. The primary outcomes were antiemetic and analgesic administrations on postoperative days (POD) 0-2.

RESULTS

After PSM, all four covariates were well balanced (all standardized mean differences ≤ 0.15). On POD 0, the VNB group required significantly fewer antiemetic administrations [0 (IQR 0-1) vs. 1 (0-1.2); p = 0.0002], analgesic administrations [0 (0-1) vs. 1 (0-2); p = 0.0020], and total drug administrations [1 (0-2) vs. 2 (1-3); p < 0.001]. No significant differences were observed on POD 1 or 2. Total drug administrations over POD 0-3 remained lower in the VNB group [5 (3-8) vs. 6.5 (3-9.2); p = 0.038]. The reduction in hospital stay observed in the unmatched analysis was attenuated after matching.

CONCLUSIONS

Intraoperative paragastric vagal nerve block with ropivacaine significantly reduces antiemetic and analgesic requirements on the day of LSG. This simple, safe technique warrants prospective evaluation in bariatric surgery.