Influence of BMI on the efficacy of ultrasound-guided erector spinae plane block in laparoscopic cholecystectomy

Background Pain after laparoscopic cholecystectomy remains a significant concern, often resulting in delayed discharge and patient discomfort. Regional anesthesia techniques like the ultrasound-guided erector spinae plane block (ESPB) have shown promise in reducing pain while minimizing opioid use. A higher BMI is associated with increased perioperative risks, including difficulty in managing anesthesia, hemodynamic instability, and higher postoperative pain levels. Objective The primary aim of the study was to assess the impact of varying BMI on the success of the block in laparoscopic cholecystectomy with respect to the time taken to perform the block, distribution, and duration of the block, and the secondary outcomes were to assess the impact of various BMI on postoperative pain, possible complications, and patient satisfaction. Patients and methods This prospective, randomized, double-blinded, controlled study included 60 patients undergoing elective laparoscopic cholecystectomy. Patients were divided into three groups based on;Deg;BM;Deg;I: group A (BMI 25–29 kg/m 2 ), group B (BMI 30–40 kg/m 2 ), and group C (BMI >40 kg/m 2 ). All patients received bilateral ultrasound-guided ESPB using 0.25% bupivacaine. Results Patients with a higher BMI demonstrated increased hemodynamic variability, particularly heart rate which was significantly higher in patients with BMI more than 40 kg/m 2 at almost all measured intervals. Patients in group C, experienced longer block times, reduced sensory block duration, and higher postoperative pain scores compared with those in groups A and B. Statistically significant differences were observed in block performance across the groups, with P values of 0.001. Postoperative pain control was less effective in group C, leading to greater reliance on rescue analgesia and higher doses of nalbuphine. Overall, patient satisfaction with the ESPB was high across all groups, though slightly lower in group C. Conclusion BMI significantly affects the performance and efficacy of ultrasound-guided ESPB in laparoscopic cholecystectomy. Yet, ESPB remains a useful analgesic technique for laparoscopic cholecystectomy.