Temporary in situ catheters to extend autonomic neural blockade after laparoscopic sleeve gastrectomy: A feasibility and safety study

Resumen

Introduction. Autonomic neural blockade (ANB) effectively reduces visceral pain, opioid and overall analgesic consumption, associated autonomic symptoms, and anesthetic requirements, while providing hemodynamic stability after laparoscopic sleeve gastrectomy (LSG). However, the limited duration of ANB remains a constraint. This study explores the use of temporary catheters to extend ANB beyond the intraoperative period.

Methods. We conducted a prospective feasibility and safety evaluation of temporary in situ catheters for postoperative ANB after LSG. Bupivacaine 0.5% and dexamethasone were administered at 12 and 24 hours postoperatively. Feasibility, technical considerations, safety observations, hemodynamic effects, and descriptive clinical responses were recorded.

Results. Catheter placement was successful in five of six cases (83%). No bleeding, procedural complications, or catheter-related adverse events were observed. Redosing was performed as planned without hemodynamic changes. Patients who exhibited postoperative visceral symptoms experienced prompt symptom improvement, temporarily associated with ANB redosing, while asymptomatic patients remained clinically stable. Catheter removal was uneventful in all cases.

Conclusions. The use of temporary in situ catheters to extend ANB beyond the intraoperative period is technically feasible and appears to be safe in patients undergoing LSG. This preliminary experience provides anatomical and technical insights into catheter type, placement, and redosing strategies. Efficacy conclusions are intentionally deferred until larger, controlled studies are conducted.