PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Following laparoscopic sleeve gastrectomy, the most frequently performed surgery for weight loss, postoperative pain may delay recovery and increase the risk of complications (Lazzati 2023; Iamaroon 2019; Barajas-Gamboa 2024). Standardised pain management protocols are needed to enhance patient recovery and ambulation, especially as the procedure is increasingly performed on an outpatient or overnight stay basis (Inaba 2018; Fortin 2020; Kaye 2019).
This review (Niels, Snijkers 2025) aimed to update the recommendations for pain management following laparoscopic sleeve gastrectomy, building upon the 2019 guidelines (Macfater 2019), which were based on data from 18 randomised controlled trials (RCTs).
The systematic review and formulation of the recommendations were performed using the unique PROSPECT methodology, available at https://esraeurope.org/prospect-methodology/. The methodology was first published in Joshi 2019 and updated in Joshi 2023. The updated literature search identified RCTs, systematic reviews and meta-analyses concerning analgesic, anaesthetic and operative interventions, with a focus on pain management for patients undergoing laparoscopic sleeve gastrectomy. EMBASE, MEDLINE, PubMed and Cochrane Databases were searched from 1 September 2018 until 4 February 2024. All included studies were critically assessed with regards to pain scores (the primary outcome), clinical relevance, effectiveness, the use of basic analgesics (paracetamol and NSAIDs/COX-2-specific inhibitors), adverse effects, and the invasiveness of the technique.
39 RCTs and two meta-analyses met the inclusion criteria.
This review is registered on PROSPERO: CRD42023487108.
COX, cyclo-oxygenase; IV, intravenous; LG, laparoscopic-guided; NSAID, non-steroidal anti-inflammatory drug; PONV, postoperative nausea and vomiting; TAP, transverse abdominal plane; USG, ultrasound-guided.
Analgesic interventions that are not recommended for pain management in patients undergoing laparoscopic sleeve gastrectomy.
IV, intravenous.
Transverse abdominal plane block and port-site local anaesthetic wound infiltration can be combined. However, care should be taken to avoid local anaesthetic systemic toxicity
COX, cyclo-oxygenase; IV, intravenous; NSAID, non-steroidal anti-inflammatory drug.
PROSPECT recommendations for laparoscopic sleeve gastrectomy – infographic
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