Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery

Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.