Comparison of Ultrasound-Guided Erector Spinae Plane and Transversus Abdominis Plane Blocks for Postoperative Analgesia in Laparoscopic Bariatric Surgery

Background: Postoperative pain management in bariatric surgery remains challenging, particularly in patients with obesity-related comorbidities that limit opioid use. Ultrasound-guided regional anesthesia techniques are therefore essential components of multimodal analgesia. Among these, the transversus abdominis plane (TAP) block and the erector spinae plane (ESP) block are commonly used, yet comparative data in bariatric surgery are limited. Methods: This retrospective observational study included adult patients who underwent elective laparoscopic sleeve gastrectomy and received either an ultrasound-guided TAP block or ESP block as part of postoperative analgesia. All patients received standardized general anesthesia and multimodal analgesia. Postoperative pain was assessed using the Visual Analog Scale and analyzed as categorical pain distributions at predefined time points. Perioperative hemodynamic parameters, time to first rescue analgesia, and postoperative adverse events were also evaluated. Results: A total of 64 patients were analyzed (TAP group, n = 30; ESP group, n = 34). Demographic characteristics, intraoperative variables, and perioperative hemodynamic parameters were comparable between groups. The proportion of pain-free patients was significantly higher in the ESP group at postoperative 2 hours, whereas pain distribution at later time points (6–48 hours) was similar between groups. Time to first rescue analgesia and the incidence of postoperative adverse events did not differ significantly. Conclusions: Both TAP and ESP blocks provided effective and safe postoperative analgesia following laparoscopic bariatric surgery. The ESP block was associated with superior early postoperative pain control, while overall analgesic efficacy and safety profiles were comparable between techniques. ESP block may be preferentially considered when enhanced early postoperative analgesia is desired.