Evidence mapPaperPMID 42249239Full record

SynthesisObesity surgery2026

Comparative Effectiveness of Fascial Plane Blocks for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

Francisco Aguilar Espinosa, Erika Diana Barba-Jaramillo, Jose Raul Valdez Aufranc, Cruz Janeth Navarro-Navarro, Pedro Hugo González-Ortega, Susana Ileana Camba-Gutiérrez

Abstract readSystematic ReviewNetwork Meta-AnalysisComparative Study
PubMed Publisher
In one paragraph

Synthesis in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Francisco Aguilar EspinosaBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Mexican Social Security Institute, Guadalajara, Mexico. franciscoaguilarresearch@gmail.com.
Erika Diana Barba-JaramilloBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Mexican Social Security Institute, Guadalajara, Mexico.
Jose Raul Valdez AufrancBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Saint Thomas Aquinas North University, San Miguel de Tucumán, Argentina.
Cruz Janeth Navarro-NavarroBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Mexican Social Security Institute, Guadalajara, Mexico.
Pedro Hugo González-OrtegaBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Mexican Social Security Institute, Guadalajara, Mexico.
Susana Ileana Camba-GutiérrezBariatric Surgery Research Center; Member, National System of Researchers (SNI) and SECIHTI, Mexican Social Security Institute, Guadalajara, Mexico.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionGlobally, laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. Multiple fascial plane blocks are used for postoperative analgesia, but their comparative efficacy remains unclear.

methodsA systematic search through January 2026 identified controlled trials comparing fascial plane blocks-including transversus abdominis plane block (TAP), erector spinae plane block (ESPB), quadratus lumborum (QL), external oblique intercostal (EOI), modified thoracoabdominal nerve block via perichondrial approach (M-TAPA), paravertebral block (PVB), and rectus sheath (RS) blocks-against each other, placebo, systemic analgesia (SA), or port-site infiltration (PSI) in LSG. The primary outcome was 24-hour opioid consumption (morphine milligram equivalents, MME). Secondary outcomes included pain scores at 2 to 24 hours, postoperative nausea and vomiting (PONV), and complications. A frequentist network meta-analysis was conducted. Treatment rankings were determined using surface under the cumulative ranking curve (SUCRA) values, and the certainty of evidence was appraised by the Grading of Recommendation Assessment, Development, and Evaluation (GRADE).

resultsTwenty-three randomized controlled trials (RCTs) comprising 2,005 patients were included. The EOI block achieved the greatest opioid-sparing effect versus SA (mean difference [MD] -19.66 MME; [SUCRA] 83%). At 24 hours, only ESPB significantly reduced pain intensity (MD -0.44). The QL block significantly decreased PONV incidence compared to placebo (odds ratio [OR] 0.31). No major block-related adverse events were reported. Overall, the quality of evidence ranged from moderate to low.

conclusionsIn adults undergoing LSG, ultrasound-guided fascial plane blocks are effective and safe for postoperative analgesia. The EOI block was probabilistically ranked highest for reducing 24-hour opioid consumption (SUCRA 83%), though CIs overlapped with other blocks. The ESPB provided a small but statistically significant reduction in pain at 24 hours (MD -0.44), and the QL was associated with the lowest incidence of PONV (OR 0.31). However, the overall certainty of evidence ranged from moderate to low, with interventions supported by limited data from only one or two trials. SUCRA rankings represent probabilistic hierarchies and should not be interpreted as definitive evidence of superiority. Consequently, technique selection should be guided by specific analgesic goals, local expertise, and individual patient factors.

Indexed as

GastrectomyLaparoscopyNerve BlockPostoperative PainHumansObesity, MorbidRandomized Controlled Trials as TopicAnalgesics, OpioidBariatric surgeryNerve blockNetwork Meta-AnalysisPostoperative pain

Identifiers

PMID42249239

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.