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Frontiers in Anesthesiology ·

Volume 5 - 2026 | https://doi.org/10.3389/fanes.2026.1826460

Erector spinae plane block on post-anesthesia care unit opioid consumption in robotic and laparoscopic sleeve gastrectomy: a retrospective observational single-center cohort analysis

  • Jessalyn Guo-Yee Yam1*corresponding author
  • Christopher Chiang1
  • Alexandra Barbaranova1
  • Alyssa Ayami Poentis1
  • Chandra Hassan2
  • Mario Alberto Masrur2
  • Huy Duc Hoang2
  • Lisa Yuko Shimotake2
  • Francesco Maria Bianco2
  • Yevhen Pavelko2
  • Michael R. Fettiplace1
  1. 1Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, United States
  2. 2Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
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Abstract

Postoperative opioid analgesia poses multiple risks to bariatric patients undergoing robotic or laparoscopic sleeve gastrectomy. Truncal blocks, including the erector spinae plane block, are utilized for perioperative pain management in abdominal and thoracic surgeries. We hypothesized that the erector spinae plane blocks would decrease opioid consumption in bariatric surgery patients. We conducted a single-center propensity-matched retrospective cohort study evaluating the impact of erector spinae plane blocks in bariatric surgery. The inclusion criteria were adults (≥18 years old) who underwent robotic or laparoscopic sleeve gastrectomy from January 2023 to November 2024. One:one nearest-neighbor propensity matching was performed using patient demographics, procedure type, and preexisting comorbidities to address confounding factors. Subgroup analysis of recovery parameters between robotic vs. laparoscopic sleeve gastrectomy was also performed. Six hundred seventy participants were identified with similar demographics and underlying conditions between the erector spinae plane (n = 240) and control (n = 430) groups. Propensity matched groups (n = 179 per group) identified that erector spinae plane block reduced post-anesthesia care unit oral morphine equivalents (−4.81 mg, 95% CI: −9.76 to −0.29, p = 0.04), intraoperative morphine equivalents (−5.85 mg, 95% CI: −9.27 to −2.42, p < 0.001), intraoperative hydromorphone (−0.11 mg, 95% CI: −0.16 to −0.04, p = <0.001), and intraoperative ketamine consumption (−6.33 mg, 95% CI: −10.98 to −1.68, p = 0.01). Multiple linear regression demonstrated significantly higher PACU opioid requirements in laparoscopic procedures compared to robotic-assisted procedures (4.64 mg, 95% CI: 0.53––8.75, p = 0.03) Erector spinae plane block resulted in a reduction in opioid consumption both during and after robotic and laparoscopic sleeve gastrectomy. Our work is consistent with randomized trials in the field, demonstrating statistically relevant decreases in opioid use, and is the first to explore its application in robotic-assisted bariatric surgery.

Keywords

1 Introduction

Worldwide, obesity is increasing dramatically, contributing to premature obesity-related deaths (1). Bariatric surgery is an effective method for achieving weight loss. It is recommended for individuals with a body mass index (BMI) ≥35 kg/m2 regardless of the presence, absence, or severity of comorbidities (2). Bariatric surgery patients commonly present with obesity-associated complications, including obstructive sleep apnea, cardiovascular disease, diabetes, and kidney disease, which result in increased perioperative risk and mortality (3). Laparoscopic sleeve gastrectomy, unlike open bariatric surgery or Roux-en-Y gastric bypass, is a minimally invasive approach to bariatric surgery, demonstrating efficacy in achieving sustained weight loss with a low complication rate (4). Robotic-assisted sleeve gastrectomy further improves tissue visualization and permits surgery on heavier patients, often contraindicated for conventional laparoscopy (5–8).

Opioids are a mainstay in postoperative pain management despite their known adverse effect on bariatric surgery patients. Significant concern for respiratory depression in obese patients persists, particularly due to the high prevalence of sleep-disordered breathing, leading to opioid induced ventilatory impairment and associated mortality (9, 10). Factors such as female gender and preoperative gastroesophageal reflux disease (GERD) contribute to increased susceptibility of postoperative nausea and vomiting (PONV) (11). Furthermore, the potential for opioid-related harm is heightened due to preexisting susceptibility to addictive habits, surgically induced pain, and possible genetic predispositions (12). As a result, the Enhanced Recovery After Surgery (ERAS) guidelines advocate for multimodal analgesia and opioid reduction strategies in bariatric patients (13).

One method to reduce opioid consumption is the use of regional anesthesia, including truncal blocks like the transversus. abdominus plane (TAP) and paravertebral blocks. However, both TAP and paravertebral blocks are technically demanding, especially in patients with increased adiposity. Additionally, TAP blocks only provide somatic analgesia and lack visceral coverage, which is a significant contributor to postoperative pain in bariatric surgery (14, 15). Alternatively, the erector spinae plane block (ESPB) is an anesthetic technique used widely in the perioperative setting, due to its ease of delivery (16). While ESPB is reported in various thoracic, abdominal, and spinal surgeries, its application in bariatric surgery remains less studied. The use of ESPB in laparoscopic bariatric surgery was first reported in 2017 (17), with multiple subsequent studies demonstrating that ESPB decreases opioid consumption (18–22). Mostafa et al. (18) found that ESPB reduced intraoperative fentanyl and 24-hour postoperative morphine consumption. Correspondingly, other randomized trials reported reductions in intraoperative remifentanil (19) and tramadol consumption in the first 24 h (20). The most recent randomized trial of ESPB in laparoscopic sleeve gastrectomy by Karaveli et al. revealed reductions in both intraoperative and postoperative opioid consumption. Despite these positive outcomes, multiple studies report conflicting findings (23, 24), with trials by Wang et al. and Jinaworm et al. demonstrating no difference in postoperative opioid consumption. Furthermore, these prior studies focus on laparoscopic sleeve gastrectomy without consideration of robotic sleeve gastrectomy. Given the prior conflicting findings and lack of exploration of ESPB in robotic sleeve gastrectomy, we conducted a retrospective cohort study on the effect of ESPB on opioid consumption after robotic and laparoscopic sleeve gastrectomy.

2 Materials and methods

2.1 Study design and population

A data analysis and statistical plan was written and filed with the University of Illinois College of Medicine Institutional Review Board (Study 2024-1104), before data were accessed. Our study was granted a waiver of Health Insurance Portability and Accountability Act (HIPAA) authorization and was therefore exempt from obtaining written patient consent for the use of protected health information. As such, we conducted a retrospective cohort review of patients who underwent robotic or laparoscopic sleeve gastrectomy, with and without ESPB, at the University of Illinois Hospital from January 2023 to November 2024, encompassing both inpatient and outpatient sleeve gastrectomies. Exclusion criteria were patients younger than 18 years of age, pregnant women, cognitively impaired adults, and/or prisoners. We extracted data using SlicerDicer on EPIC (EPIC Systems, Verona, Wisconsin), our institution's electronic health record system. Demographic and clinical data, including gender, age, race, BMI, pre-existing comorbidities, American Society of Anesthesiologists (ASA) physical status, history of postoperative nausea and vomiting (PONV), and type of surgery (robot-assisted vs. non-robot-assisted), were collected. The pre-existing comorbidities reported were hypertension, obstructive sleep apnea, asthma, end-stage renal disease, diabetes mellitus, and coronary artery disease.

When available, the surgical course and postoperative outcomes were extracted, including total anesthetic time, total operative time, minutes in recovery to out of recovery, hospital recovery stay days, highest pain score in recovery, number of prophylactic antiemetics administered, and presence of PONV in the post-anesthesia care unit (PACU). The amount of local anesthetic, either bupivacaine HCl 0.25% or ropivacaine HCl 0.20% injection solution, administered in each block was also recorded. Medication administrations for all patients were documented, including PACU oral morphine milligram equivalents (MME), intraoperative MME, and postoperative MME at various time points (6, 24, and 48 h), as well as intraoperative consumption of fentanyl, hydromorphone, ketamine, ondansetron, and dexamethasone. The primary aim of this study is to assess the effect of ESPB on PACU opioid consumption. Our secondary aims are to evaluate the impact of ESPB on intraoperative opioid consumption and postoperative clinical outcomes, including the presence of PONV, total operative time, pain score in recovery, and length of stay.

2.2 Statistical analysis

All statistical analyses were conducted using GraphPad Prism Version 10.5.0 (673) and STATA Version 13.1 and were performed with a significance threshold of p < 0.05. Categorical data (sex, race, history of PONV, ASA physical status, pre-existing comorbidities, and robot- vs. non-robot-assisted surgery) were compared using chi-squared test. Normally distributed continuous data (BMI and age) were compared using an independent sample t-test. Non-normally distributed continuous data (surgical course, postoperative outcomes, and medication administration) were compared using Mann–Whitney U-test. A subgroup analysis of the conditions listed above was performed to compare outcomes of robotic and laparoscopic sleeve gastrectomy with ESPB use. We performed a complete-case analysis for patient characteristics (Tables 1, 2); however, missing data for sex and BMI was significant (>10%). Complete-case analysis for intraoperative and postoperative outcomes (Table 3) was also performed as missing data was minimal (<1.5%).

Table 1. Demographics and baseline characteristics before and after propensity-score matching.

Preoperative CharacteristicsBefore matchingAfter matching
Total (N = 670)ESPB Group (n = 240)Control Group (n = 430)p-valueTotal (n = 358)ESPB Group (n = 179)Control Group (n = 179)p-value
Age (years), mean (SD)41.1 (11)41.9 (11)40.7 (11)0.1541.9 (11)41.7 (11)42.5 (11)0.68
Sex, n (%)0.520.77
Male79 (12)31 (13)48 (11)58 (16)28 (16)30 (17)
Female506 (75)180 (75)326 (76)300 (84)151 (84)149 (83)
Not Reported85 (13)29 (12)56 (13)
Race, n (%)0.910.94
Black411 (61)146 (61)265 (62)217 (61)107 (60)110 (61)
White199 (30)71 (30)128 (30)113 (32)58 (32)55 (31)
Other60 (9)23 (10)37 (9)28 (8)14 (8)14 (8)
BMI (kg/m2), mean (SD)a48.5 (10)48.2 (9.6)48.6 (10)0.6548.2 (10)48.6 (10)47.8 (10)0.68
ASA Score, n (%)b0.790.81
II49 (7)17 (7)32 (7)23 (6)10 (6)13 (7)
III605 (90)217 (90)389 (90)331 (91)167 (93)164 (92)
IV11 (2)5 (2)6 (1)4 (1)2 (1)2 (1)
History of PONV, n (%)28 (4)11 (4)17 (3)0.6914 (4)9 (5)5 (3)0.28
Comorbidities, n (%)
HTN332 (50)126 (53)206 (48)0.25189 (53)98 (55)91 (51)0.46
OSA143 (2)53 (22)90 (21)0.7383 (23)42 (23)41 (23)0.90
Asthma140 (2)49 (20)91 (21)0.8274 (21)36 (20)38 (21)0.79
ESRD13 (2)5 (2)8 (2)0.847 (2)4 (2)3 (2)0.70
DM (Type I and II)25 (4)7 (3)18 (4)0.4113 (4)4 (2)9 (5)0.16
CAD22 (3)10 (4)12 (3)0.3412 (3)7 (4)5 (3)0.56
Primary procedure, n (%)0.440.83
Laparoscopic SG393 (59)136 (57)257 (60)192 (54)95 (53)97 (54)
Robot-assisted SG277 (41)104 (43)173 (40)166 (46)84 (47)82 (46)
Local Anesthetic in mL, median (IQR)0 [0–60]60 [60–60]0 [0–0]<0.0010 [0–60]60 [60–60]0 [0–0]<0.001
Bupivacaine HCl 0.25%, n (%)197 (29)190 (79)7 (3)164 (46)159 (88)5 (3)
Ropivacaine HCl 0.20%, n (%)43 (6)41 (17)2 (1)13 (4)12 (7)1 (1)

Thirty-six and eighty-nine missing data in the ESPB and control groups before matching, respectively.

One and three missing data in the ESPB and control groups before matching, respectively.

ASA, American Society of Anesthesiologists; BMI, body mass index; CAD, coronary artery disease; DM, diabetes mellitus; ESPB, erector spinae plane block; ESRD, end-stage renal disease; HTN, hypertension; OSA, obstructive sleep apnea; PONV, postoperative nausea and vomiting; SD, standard deviation: SG, sleeve gastrectomy.

Table 2. Demographics and baseline characteristics of subgroup analysis.

Preoperative CharacteristicsESPB Group (n = 179)Control Group (n = 179)
Robotic (n = 84)Laparoscopic (n = 95)p-valueRobotic (n = 82)Laparoscopic (n = 97)p-value
Age (years), mean (SD)40.4 (12)42.9 (10)0.1440.7 (11)43.1 (11)0.02
Sex, n (%)0.720.61
Male14 (17)14 (15)15 (18)15 (15)
Female70 (83)81 (85)67 (82)82 (85)
Race, n (%)
Black57 (68)50 (53)0.0158 (71)52 (54)0.03
White18 (21)40 (42)17 (21)38 (39)
Other9 (11)5 (5)7 (8)7 (7)
BMI (kg/m2), mean (SD)55.3 (9.4)42.8 (4.9)<0.00153.9 (10)42.7 (5.4)<0.001
ASA Score, n (%)0.06<0.007
II1 (1)9 (9)1 (1)12 (12)
III82 (98)85 (90)80 (98)84 (87)
IV1 (1)1 (1)1 (1)1 (1)
History of PONV, n (%)1 (1)8 (8)0.033 (4)2 (2)0.52
Comorbidities, n (%)
HTN47 (56)51 (54)0.7640 (49)51 (53)0.61
OSA23 (27)19 (20)0.2419 (23)22 (23)0.94
Asthma18 (21)18 (19)0.6816 (20)22 (23)0.61
ESRD2 (2)2 (2)0.911 (1)2 (2)0.66
DM (Type I and II)1 (1)3 (3)0.372 (2)7 (7)0.15
CAD0 (0)7 (7)0.011 (1)4 (4)0.24
Local Anesthetic in mL, median (IQR)60 [60–60]60 [60–60]0.830 [0–0]0 [0–0]0.69
Bupivacaine HCl 0.25%, n (%)71 (85)88 (93)2 (2)3 (3)
Ropivacaine HCl 0.20%, n (%)6 (7)6 (6)0 (0)1 (1)

ASA, American Society of Anesthesiologists; BMI, body mass index; CAD, coronary artery disease; DM, diabetes mellitus; ESPB, erector spinae plane block; ESRD, end-stage renal disease; HTN, hypertension; OSA, obstructive sleep apnea; PONV, postoperative nausea and vomiting; SD, standard deviation; SG, sleeve gastrectomy.

Table 3. Intraoperative and postoperative outcomes of participants.

VariableESPB Group (n = 240)Control Group (n = 430)Total (N = 670)
Robotic (n = 104)Laparoscopic (n = 136)p-valueRobotic (n = 173)Laparoscopic (n = 257)p-valueESPB Group (n = 240)Control Group (n = 430)p-value
Total anesthetic time (min)a136 [120–160]114 [99–127]<0.001143 [120–168]110 [98–121]<0.001123 [108–140]118 [103–143]0.47
Total operative time (min)b83 [71–103]58 [49–74]<0.00191 [70–117]61 [50–74]<0.00170 [55–87]69 [55–91]0.49
In recovery to out of recovery (min)c115 [80–151]99 [72–142]0.09113 [85–144]112 [81–157]0.57108 [75–144]113 [82–152]0.27
Hospital recovery stay daysd3 [2–3]2 [2–3]0.012 [2–3]2 [2–3]0.042 [2–3]2 [2–3]0.68
Pain score in recovery (highest)e8 [6–9]8 [6–9]0.758 [7–10]8 [7–9]0.528 [6–9]8 [7–9]0.36
Number of prophylactic antiemetics administeredf2 [2–3]2 [2–3]0.832 [2–2]2 [2–2]0.252 [2–3]2 [2–2]0.10
Presence of PONV in PACU, n (%)g72 [69]72 [53]0.01108 [62]159 [62]0.93144 [60]271 [63]0.44

Two missing data in control group.

Three and four missing data in the ESPB and control groups, respectively.

One and three missing data in the ESPB and control groups, respectively.

Two missing data in control group.

Three and five missing data in the ESPB and control groups, respectively.

Two missing data in control group.

Three missing data in control group.

ESPB, erector spinae plane block; PACU, post-anesthesia care unit; PONV, postoperative nausea and vomiting.

Propensity score matching was used to estimate the average treatment effect on the treated of receiving an ESPB. 1:1 nearest-neighbor matching without replacement was performed using a caliper width of 0.2. Patients were matched on primary procedure type (laparoscopic vs. robotic), age at encounter, BMI, sex assigned at birth, and race. Patients with missing covariate data were excluded from matching. The sample size was calculated to detect the reduction of 4 mg PACU MME [d = 0.23], equivalent to 0.2 mg hydromorphone, a standard dose at our institution, resulting in at least 225 participants in each study group to obtain 80% power with a significance level of 0.05.

Finally, an exploratory multivariable linear regression model was performed to evaluate factors associated with PACU opioid consumption. Independent variables included age, sex assigned at birth, race, BMI, ASA score, primary surgical procedure, and the use of ESPB. The least frequent variables were selected as references. Assumption of normality was visually assessed using a Q-Q plot. Homoscedasticity was visually evaluated by inspecting residuals against fitted values and was found to be generally constant across the range of predicted values. No evidence of multicollinearity was found, as all tolerance values were >0.1. Due to unreported data, a total of 473 participants were included in the linear regression model.

Generative AI technology, including ChatGPT (GPT-4o, May 2025) and Grammarly, was used to improve the fluency and clarity in the introduction and discussion sections. No data was entered into these tools consistent with recommendations in the regional anesthesia community (25).

3 Results

3.1 Patient characteristics

We included 670 patients in this study, including 240 ESPB patients and 430 control patients. Using 1:1 nearest neighbor propensity score matching, 179 pairs were matched. Baseline patient characteristics were broadly similar in the two groups before and after matching, with similar ages, BMI, and comorbidities (Table 1). Patients were predominantly female, African American or Black, with an ASA III physical status with comorbid hypertension, obstructive sleep apnea, and asthma. As anticipated, local anesthetics were significantly increased in the ESPB groups, although minimal amounts were also present in the control groups. Total local anesthetic volume (bupivacaine HCl 0.25% +ropivacaine HCl 0.2%) was significantly higher in the ESPB group compared to controls both before matching [60 (60–60) vs. 0 (0–0), p < 0.001] and after matching [60 (60–60) vs. 0 (0–0), p < 0.001]. Before matching, 79% (n = 190) of ESPB patients received bupivacaine and 17% (n = 41) received ropivacaine, compared to 3% (n = 7) and 1% (n = 2) in the control group, respectively. After matching, 88% (n = 159) of ESPB patients received bupivacaine and 7% (n = 12) received ropivacaine, compared to 3% (n = 5) and 1% (n = 1) in controls, respectively.

Baseline characteristics among patients who received a robotic vs. laparoscopic sleeve gastrectomy were further evaluated. Subgroup analysis of robotic vs. laparoscopic sleeve gastrectomy in patients who received an ESPB revealed significant differences in BMI (before matching: 55.3 ± 9.4 kg/m2 vs. 42.8 ± 4.9 kg/m2, p < 0.001; after matching: 53.9 ± 10.0 kg/m2 vs. 42.7 ± 5.4 kg/m2, p < 0.001), history of PONV (before matching only: 1% vs. 8%, p = 0.03), and presence of coronary artery disease (CAD, before matching only: 0% vs. 7%, p = 0.01) before surgery (Table 2).

3.2 Outcomes with stratification

Analysis of the intraoperative course and postoperative outcomes revealed no significant differences between the ESPB and non-ESPB groups (Table 3). However, subgroup analysis revealed longer total anesthetic time and total operative time, and increased hospital recovery stay days in the robotic sleeve gastrectomy group with and without ESPB. Higher rates of PONV in PACU were observed in the robotic sleeve gastrectomy group who received ESPB.

ESPB resulted in lower PACU MME (Table 4), intraoperative MME, intraoperative fentanyl, intraoperative hydromorphone, and intraoperative ketamine consumption. There was no change in antiemetic administration in the ESPB group compared to the control group. Further analysis of medication administrations in robotic vs. laparoscopic sleeve gastrectomy revealed no significant differences in opioid consumption among all time points, but identified increased ketamine use in robotic sleeve gastrectomy.

Table 4. Medication administration data of participants.

Perioperative CharacteristicsESPB Group (n = 240)Control Group (n = 430)Total (N = 670)
Robotic (n = 104)Laparoscopic (n = 136)p-valueRobotic (n = 173)Laparoscopic (n = 257)p-valueESPB Group (n = 240)Control Group (n = 430)p-value
PACU morphine equivalents (mg)30 [15–35]30 [15–40]0.2630 [15–42]34 [15–45]0.2030 [15–38]30 [15–44]0.01
Intraoperative morphine equivalents (mg)34 [30–39]34 [30–38]0.9038 [30–49]38 [30–46]0.2434 [30–38]38 [30–46]<0.001
Postoperative morphine equivalents (6 h) (mg)35 [19–46]35 [23–46]0.5535 [23–50]38 [30–50]0.1235 [23–46]38 [23–50]0.09
Postoperative morphine equivalents (24 h) (mg)38 [23–50]38 [27–51]0.3939 [23–52]42 [30–53]0.1438 [24–50]42 [28–53]0.08
Postoperative morphine equivalents (48 h) (mg)38 [23–53]40 [27–54]0.5541 [23–55]43 [31–55]0.3538 [27–54]42 [30–55]0.06
Intraoperative fentanyl consumption (mcg)100 [100–100]100 [100–100]0.42100 [100–150]100 [100–113]0.62100 [100–100]100 [100–125]0.03
Intraoperative hydromorphone consumption (mg)0.2 [0–0.4]0.2 [0–0.4]0.610.4 [0–0.4]0.4 [0–0.4]0.130.2 [0.2–0.4]0.4 [0–0.4]<0.001
Intraoperative ketamine consumption (mg)15 [0–30]0 [0–30]0.0120 [0–43]20 [0–30]0.020 [0–30]20 [0–40]<0.001
Intraoperative ondansetron consumption (mg)4 [4–4]4 [4–4]0.344 [4–4]4 [4–4]0.044 [4–4]4 [4–4]0.92
Intraoperative dexamethasone consumption (mg)8 [4–8]4 [4–8]0.278 [4–8]8 [4–8]0.908 [4–8]8 [4–8]0.53

ESPB, erector spinae plane block; PACU, post-anesthesia care unit.

3.3 Outcomes following propensity matching

Following propensity score matching, the reduction in opioid use persisted with ESPB associated with a decrease in PACU MME, intraoperative MME, intraoperative hydromorphone, and intraoperative ketamine consumption (Table 5).

Table 5. Propensity score analysis of ESPB effects.

VariablesCoefficientAbsolute difference (95% CI)p-value
PACU morphine equivalents (mg)−4.81(−9.76 to −0.29)0.04
Intraoperative morphine equivalents (mg)−5.85(−9.27 to −2.42)<0.001
Postprocedure Morphine Equivalents (6 h) (mg)−1.72(−6.11 to 2.68)0.44
Postprocedure Morphine Equivalents (24 h) (mg)−3.42(−8.57 to 1.74)0.19
Postprocedure Morphine Equivalents (48 h) (mg)−2.82(−8.03 to 2.40)0.29
Intraoperative fentanyl consumption (mcg)−8.75(−19.18 to 1.68)0.10
Intraoperative hydromorphone consumption (mg)−0.11(−0.16 to −0.04)<0.001
Intraoperative ketamine consumption (mg)−6.33(−10.98 to −1.68)0.01
Intraoperative ondansetron consumption (mg)0.07(−0.12 to 0.28)0.45
Intraoperative dexamethasone consumption (mg)−0.31(−1.00 to 0.38)0.37
Pain score in recovery (highest)−0.49(−1.03 to 0.05)0.08
In recovery to out of recovery (min)−6.33(−22.82 to 10.16)0.45
Hospital recovery stay (days)0.13(−0.11 to 0.38)0.30
PONV in PACU0.07(−0.18 to 0.05)0.24

CI, confidence interval; ESPB, erector spinae plane block; PACU, post-anesthesia care unit; PONV, postoperative nausea and vomiting.

3.4 Factors associated with PACU opioid consumption

A linear regression was conducted to assess contributors to PACU opioid use (Table 6). The model identified younger age, laparoscopic sleeve gastrectomy, and lack of ESPB as contributors to increased PACU opioid use.

Table 6. Linear regression model for PACU opioid consumption.

Variablesβ Estimate (95% CI)/t/ Statisticp-value
Age (years)−0.18 (−0.33 to −0.03)2.280.02
Sex
Male1 [Reference]1 [Reference]NA
Female−4.57 (−9.30 to 0.16)1.900.06
Race
Black−1.18 (−7.12 to 4.76)0.390.70
White−3.68 (−9.89 to 2.54)1.160.25
Other1 [Reference]1 [Reference]NA
BMI (kg/m2)−0.00 (−0.21 to 0.20)0.030.98
ASA Physical Status
II0.47 (−14.90 to 15.83)0.060.95
III3.58 (−10.52 to 17.69)0.500.62
IV1 [Reference]1 [Reference]NA
Primary Procedure
Laparoscopic SG4.64 (0.53 to 8.75)2.220.03
Robot-assisted SG1 [Reference]1 [Reference]
ESPB Used?
Yes1 [Reference]1 [Reference]NA
No3.81 (0.56 to 7.06)2.300.02

ASA, American Society of Anesthesiologists; BMI, body mass index; CI, confidence interval; ESPB, erector spinae plane block; SG, sleeve gastrectomy.

4 Discussion

Our retrospective cohort study identified that bilateral ESPB reduced both intraoperative and postoperative opioid administration in robotic and laparoscopic sleeve gastrectomy. These results are consistent with several randomized controlled trials, demonstrating a similar effect in laparoscopic sleeve gastrectomy (18, 21, 23). Notably, this is the first report of opioid use in patients undergoing robotic sleeve gastrectomy, confirming that the effect is maintained across both procedures. After propensity matching for patient demographics, procedure length, and procedure type (robotic vs. laparoscopic sleeve gastrectomy), our study revealed significant reductions in intraoperative MME, PACU MME, intraoperative hydromorphone, and intraoperative ketamine. We calculated a perioperative reduction of 10.66 MME in patients who received an ESPB. However, the absence of corresponding improvements in other patient outcomes, including PONV, pain scores, and length of stay, raises questions about whether ESPB is the optimal regional anesthesia method for bariatric surgery.

Nerve blocks, both peripheral and fascial plane, can reduce perioperative opioid consumption, and is true for truncal blocks for abdominal and thoracic surgery. ESPB is an attractive analgesic choice in bariatric surgery due to the desire to reduce perioperative opioid use and the ease of delivery compared with other blocks (e.g., paravertebral blocks). A meta-analysis by Nair et al. identified that bilateral ESPB in bariatric surgery reduced both intraoperative and 24-hour postoperative opioid consumption, but the reductions were modest (22). A retrospective study by Karaca et al. identified that bilateral ESPB in laparoscopic bariatric surgery reduced both postoperative fentanyl consumption and numeric pain scores up to 72 h. However, baseline characteristics, including BMI and ASA scores, differed significantly between groups, potentially leading to confounding results (26). This systematic review and meta-analysis should be interpreted with caution due to the limited literature available, which included six studies with significant design heterogeneity, resulting in inconsistent findings. Prior randomized trials that recorded visual analog scale (VAS) pain scores found overall improvement with ESPB use (18, 19, 23). Two studies reported significantly lower VAS scores at all postoperative time points (19, 23), while Mostafa et al. noted improvements only in the first eight hours. Multiple studies also reported improvement in numerical pain scores over varying time intervals (20, 22). Randomized trials assessing quality of recovery (QoR) scores present conflicting evidence. The QoR-15 (23) and Thai QoR-35 questionnaires (24) showed no improvement with ESPB, though Wang et al. noted enhanced emotional state score. In contrast, Toprak et al. reported a small but statistically significant increase in QoR-40 scores for the ESPB group, indicating only a mild clinical improvement (20).

Studies on postoperative pulmonary function and the prevalence of PONV generally agree on the lack of significant differences (18, 21–23), though a recent meta-analysis by Zhao et al. found a significant reduction in PONV with the use of an ESPB. However, it remains unclear whether this conclusion fully addresses our question, given the lack of subgroup analysis by surgical type. Additionally, it is uncertain whether ESPB directly reduces PONV through the proposed inhibition of visceral sensory innervation or if it does so indirectly by decreasing opioid (27). The lack of consistency among recent literature and the limited evidence available underscores the need for more rigorously designed studies to determine the efficacy of ESPB in bariatric surgery.

Though our findings are consistent with prior work demonstrating a reduction in perioperative opioid consumption with the use of ESPB in bariatric surgery, we did not observe a change in the highest pain scores reported between the ESPB and control group. Beyond this, the use of an ESPB did not translate to other outcomes, such as rates of PONV or length of stay. As such, we must ask if ESPB is the optimal regional anesthetic strategy for robotic and laparoscopic sleeve gastrectomy. Compared to neuraxial approaches like paravertebral blocks, the ESPB is less targeted and not as effective for anesthetic-level pain control. Furthermore, the ESPB requires large volumes of local anesthetic that put patients at risk of local anesthetic systemic toxicity (28, 29), especially in patients with a high actual body weight but a low lean body weight, as seen in bariatric patients (30). Therefore, we must consider if alternative approaches like the paragastric autonomic neural blockage (31) might be a better choice of regional anesthesia for bariatric surgery.

Our findings contribute to the ongoing discussion surrounding ESPB in laparoscopic sleeve gastrectomy, as we are the first to characterize its application in robotic-assisted bariatric surgery. The adoption of a robotic approach to sleeve gastrectomy has seen an annual growth rate of 2.87-fold from 2015 to 2020; this trend continues to rise, likely due to the ergonomic advantages and enhanced visualization of the operative field (32). However, comparative literature regarding the application of this newer regional anesthesia technique and its impact on postoperative pain between robotic and laparoscopic sleeve gastrectomy is still limited. A systematic review by Gill et al. compared the traditional laparoscopic approach with the novel robotic platform and demonstrated that robotic assistance is a safe and feasible option in bariatric surgery (33). One previous study reported no significant differences in inpatient opioid administrations or pain management between robotic and laparoscopic sleeve gastrectomy (34). Another retrospective cohort study reported a reduction in opioid prescriptions for robotic sleeve gastrectomy patients at the time of discharge; however, no other clinical benefits were observed (5). A more recent study focusing on pain and analgesic requirement following robotic and laparoscopic sleeve gastrectomy was conducted, though a TAP block was included as part of their standardized protocol (35). Among these reports, postoperative pain differences between robotic and laparoscopic sleeve gastrectomy are limited and do not adequately address the impact of novel peripheral and fascial nerve blocks. This is further illustrated by the 2025 procedure-specific postoperative pain management (PROSPECT) recommendations, which are tailored for laparoscopic sleeve gastrectomy, rather than robotic procedures, despite the latter's growing use in (36).

Our study contributes to the robotic literature by identifying slightly higher PACU opioid requirements in laparoscopic procedures, after controlling for baseline characteristics (Table 6). Univariate analysis of medication administrations (Table 4) provided contradicting results, revealing no significant differences in opioid consumption during the perioperative course between patients who received robotic vs. laparoscopic sleeve gastrectomy. The observed discrepancy likely arises from differences between unadjusted and multivariable analyses, the latter of which account for potential confounders and further reinforce the conclusion that ESPB reduces opioid consumption in bariatric surgery. As expected, robotic-assisted procedures resulted in longer procedure and anesthesia times along with extended hospital stays, both in the ESPB and control groups. The increased hospital stay was not particularly large, especially given that the patients in the robotic sleeve gastrectomy group had BMIs over 10 points higher than the laparoscopic sleeve gastrectomy group. However, additional work is needed to identify methods to reduce hospitalization time since extended hospital stays are associated with an increased risk of in-hospital complications, greater resource utilization resulting in higher hospital costs, and reduced patient satisfaction (37, 38). We also identified a higher incidence of PONV in the PACU for robotic surgery patients, which align with the current literature. The increased PONV may lead to a prolonged length of stay, as sufficient oral intake is required before discharge and may be an important factor to reduce length of stay (39). While our study population included a diverse sample with respect to patient characteristics, comorbidities, and procedure types, it is important to note that the inclusion criteria at our institution for robotic sleeve gastrectomy patients consist of individuals with a BMI greater than 50, those with a complex history of previous surgeries, and patients undergoing revisional cases after having had prior bariatric surgery. These outcomes are likely influenced by both the prevalence of PONV and severely increased BMI, which correspond with higher rates of mortality, readmissions, and postoperative interventions observed among all groups of robotic surgery patients included in this study (7).

4.1 Limitations

Our study is not without limitations. Based upon our pre-hoc power analysis, the study was underpowered; despite this, we still observed a reduction in opioid requirements, including decreased PACU and intraoperative MME, in the experimental group. Further limitations include its single-center design and the use of multiple anesthetic agents for ESPB (ropivacaine and bupivacaine). Specifically, some procedures were performed with bupivacaine HCl 0.25% solution, while others utilized ropivacaine HCl 0.20% solution. Notably, local anesthetic documentation was absent for ten patients, and one patient received both bupivacaine and ropivacaine. Furthermore, we did not account for the nine patients who received a local anesthetic without a corresponding block, likely as a local surgical wound infiltration. Additionally, a change in our institution's electronic health record system resulted in missing sex and BMI documentation for patients who received surgery from January to April 2023, potentially altering baseline patient characteristics. This transition narrowed our data pool, as ESPB in bariatric surgery was not properly documented until January 2023.

4.2 Conclusion

In our retrospective, propensity-matched cohort study, we identified a reduction in intraoperative and postoperative opioid consumption with the use of ESPB in both robotic and laparoscopic sleeve gastrectomy. This reinforces prior literature (18, 21, 23) demonstrating the association between reduced opioid use and the implementation of regional anesthesia techniques in bariatric surgery, and marks the first time that ESPB has been specifically reported in robotic sleeve gastrectomy. However, the reduction in opioid use was minimal and was not accompanied by improvements in other clinical outcomes, including rates of PONV or length of stay. As such, our results raise the question of whether alternative techniques may provide more targeted pain control strategies in robotic and laparoscopic sleeve gastrectomy. Alternative considerations may include novel approaches such as suzetrigine (40) and paragastric autonomic neural blockade (31).

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fanes.2026.1826460/full#supplementary-material

Supplementary material Supplementary material at the source

Footnotes

Edited by: Federico Piccioni, Anesthesia and Perioperative Medicine Unit—IRCCS Humanitas Research Hospital, Italy

Reviewed by: Giuliano Bolondi, Maurizio Bufalini Hospital, Italy

Katsushi Doi, Saitama Medical University, Japan

Statements

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Data availability

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

Ethics approval

The studies involving humans were approved by Office for the Protection of Research Subjects (OPRS) at Univeristy of Illinois Chicago Human Research Protection Program (HRPP). The studies were conducted in accordance with the local legislation and institutional requirements. The ethics committee/institutional review board waived the requirement of written informed consent for participation from the participants or the participants' legal guardians/next of kin because this study involved a retrospective review of existing medical records, posed minimal risk to participants, and could not practicably be carried out if consent were required. All data were de-identified and handled in accordance with institutional privacy and confidentiality guidelines.

Author contributions

JY: Validation, Data curation, Formal analysis, Conceptualization, Writing – original draft, Writing – review & editing, Methodology. CC: Conceptualization, Supervision, Writing – review & editing. AB: Writing – review & editing, Formal analysis. AP: Writing – review & editing. CH: Writing – review & editing. MM: Writing – review & editing. HH: Writing – review & editing. LS: Writing – review & editing. FB: Writing – review & editing. YP: Writing – review & editing. MF: Supervision, Methodology, Writing – review & editing, Conceptualization, Writing – original draft, Project administration, Validation, Formal analysis.

References

  1. 1. Lingvay I, Cohen RV, Le Roux CW, Sumithran P. Obesity in adults. Lancet. (2024) 404 (10456): 972 – 87. doi:10.1016/S0140-6736(24)01210-8
  2. 2. Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV 2022 American society for metabolic and bariatric surgery (ASMBS) and international federation for the surgery of obesity and metabolic disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. (2022) 18 (12): 1345 – 56. doi:10.1016/j.soard.2022.08.013
  3. 3. Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M The science of obesity management: an endocrine society scientific statement. Endocr Rev. (2018) 39 (2): 79 – 132. doi:10.1210/er.2017-00253
  4. 4. Acosta A, Streett S, Kroh MD, Cheskin LJ, Saunders KH, Kurian M White paper AGA: pOWER—practice guide on obesity and weight management, education, and resources. Clin Gastroenterol Hepatol. (2017) 15 (5): 631 – 49.e10. doi:10.1016/j.cgh.2016.10.023
  5. 5. Saleh T, Ford J, Kindel T, Higgins R, Lak K, Gould J Inpatient opioid use and pain control after robotic versus laparoscopic sleeve gastrectomy. Surgery. (2024) 175 (3): 599 – 604. doi:10.1016/j.surg.2023.08.064
  6. 6. Tatarian T, Yang J, Wang J, Docimo S, Talamini M, Pryor AD Trends in the utilization and perioperative outcomes of primary robotic bariatric surgery from 2015 to 2018: a study of 46,764 patients from the MBSAQIP data registry. Surg Endosc. (2021) 35 (7): 3915 – 22. doi:10.1007/s00464-020-07839-3
  7. 7. Zevallos A, Cornejo J, Brown J, Sarmiento J, Shojaeian F, Mokhtari-Esbuie F The role of robotic sleeve gastrectomy in patients with super super obesity using the 2019–2022 MBSAQIP database. Surg Endosc. (2024) 38 (8): 4594 – 603. doi:10.1007/s00464-024-10955-z
  8. 8. Sebastian R, Howell MH, Chang K-H, Adrales G, Magnuson T, Schweitzer M Robot-assisted versus laparoscopic roux-en-Y gastric bypass and sleeve gastrectomy: a propensity-score matched analysis using the 2015–2016 MBSAQIP database. Surg Endosc. (2019) 33 (5): 1600 – 12. doi:10.1007/s00464-018-6422-7
  9. 9. Talab HF, Zabani IA, Abdelrahman HS, Bukhari WL, Mamoun I, Ashour MA Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. Anesth Analg. (2009) 109 (5): 1511 – 6. doi:10.1213/ANE.0b013e3181ba7945
  10. 10. Chung SA, Yuan H, Chung F. A systematic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. (2008) 107 (5): 1543 – 63. doi:10.1213/ane.0b013e318187c83a
  11. 11. Rashad AE, El Hefnawy E, Elmorshedi M, Abuyousif YA, Salem A, Attia M Prevalence, risk factors, and management of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a retrospective multicentric study. Obes Surg. (2023) 33 (10): 3237 – 45. doi:10.1007/s11695-023-06803-z
  12. 12. Wuyts SCM, Torensma B, Schellekens AFA, Kramers C(K). Opioid analgesics after bariatric surgery: a scoping review to evaluate physiological risk factors for opioid-related harm. J Clin Med. (2023) 12 (13): 4296. doi:10.3390/jcm12134296
  13. 13. Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. (2016) 40 (9): 2065 – 83. doi:10.1007/s00268-016-3492-3
  14. 14. Mu T, Chen K, Xu Y, Hao Y, Liu D, Wei K. Comparison between erector spinae plane block at T9 level and transversus abdominis plane block for postoperative analgesia and recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. Obes Surg. (2025) 35 (6): 2249 – 63. doi:10.1007/s11695-025-07920-7
  15. 15. Yang G, Wang P, Yin Y, Qu H, Zhao X, Jin X Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. PeerJ. (2024) 12: e17431. doi:10.7717/peerj.17431
  16. 16. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. (2016) 41 (5): 621 – 7. doi:10.1097/AAP.0000000000000451
  17. 17. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of three cases. Reg Anesth Pain Med. (2017) 42 (3): 372 – 6. doi:10.1097/AAP.0000000000000581
  18. 18. Mostafa SF, Abdelghany MS, Abu Elyazed MM. Ultrasound-guided erector spinae plane block in patients undergoing laparoscopic bariatric surgery: a prospective randomized controlled trial. Pain Pract. (2021) 21 (4): 445 – 53. doi:10.1111/papr.12975
  19. 19. Zengin SU, Ergun MO, Gunal O. Effect of ultrasound-guided erector spinae plane block on postoperative pain and intraoperative opioid consumption in bariatric surgery. Obes Surg. (2021) 31 (12): 5176 – 82. doi:10.1007/s11695-021-05681-7
  20. 20. Toprak H, Başaran B, Toprak ŞS, Et T, Kumru N, Korkusuz M Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery: a randomized controlled trial. Obes Surg. (2023) 33 (9): 2640 – 51. doi:10.1007/s11695-023-06748-3
  21. 21. Karaveli A, Kaplan S, Kavakli AS, Kosar MN, Mayir B. Effect of ultrasound-guided erector spinae plane block on postoperative opioid consumption and respiratory recovery in laparoscopic sleeve gastrectomy: a randomized controlled study. Obes Surg. (2025) 35 (1): 112 – 21. doi:10.1007/s11695-024-07576-9
  22. 22. Nair AS, Rangaiah M, Dudhedia U, Borkar NB. Analgesic efficacy and outcomes of ultrasound-guided erector spinae plane block in patients undergoing bariatric and metabolic surgeries: a systematic review. J Med Ultrasound. (2023) 31 (3): 178 – 87. doi:10.4103/jmu.jmu_112_22
  23. 23. Wang Y, Zuo S, Ma Y, Shen J, Chu Q, Yang Z. Effect of ultrasound-guided erector spinae plane block on recovery after laparoscopic sleeve gastrectomy in patients with obesity: a randomized controlled trial. Clin Ther. (2023) 45 (9): 894 – 900. doi:10.1016/j.clinthera.2023.07.010
  24. 24. Jinaworn P, Pannangpetch P, Bunanantanasan K, Manomaisantiphap S, Udomsawaengsup S, Thepsoparn M Efficacy of erector spinae plane block on postoperative analgesia for patients undergoing metabolic bariatric surgery: a randomized controlled trial. Obes Surg. (2024) 34 (11): 4211 – 9. doi:10.1007/s11695-024-07515-8
  25. 25. Fettiplace MR, Bhatia A, Chen Y, Orebaugh SL, Gofeld M, Gabriel RA Recommendations for disclosure of artificial intelligence in scientific writing and publishing: a regional anesthesia and pain medicine modified delphi study. Reg Anesth Pain Med. (2025): rapm-2025-106852. doi:10.1136/rapm-2025-106852
  26. 26. Karaca O, Polat Y. Efficacy of ultrasound-guided bilateral erector spinae plane block for postoperative analgesia in laparoscopic sleeve gastrectomy. A retrospective cohort study. Ann Med Res. (2020) 27: 2719 – 25. doi:10.5455/annalsmedres.2020.04.397
  27. 27. Zhao C, Zhu M, Jian J, Zeng J. Erector spinae plane block reduces postoperative nausea and vomiting: a systematic review and meta-analysis of 44 randomized trials. Front Med (Lausanne). (2026) 12: 1749998. doi:10.3389/fmed.2025.1749998
  28. 28. Bungart B, Joudeh L, Fettiplace M. Local anesthetic dosing and toxicity of adult truncal catheters: a narrative review of published practice. Reg Anesth Pain Med. (2024) 49 (3): 209 – 22. doi:10.1136/rapm-2023-104667
  29. 29. Schwenk ES, Lam E, Abulfathi AA, Schmidt S, Gebhart A, Witzeling SD Population pharmacokinetic and safety analysis of ropivacaine used for erector spinae plane blocks. Reg Anesth Pain Med. (2023) 48 (9): 454 – 61. doi:10.1136/rapm-2022-104252
  30. 30. Fettiplace M. Weight-based dosing of ropivacaine in erector spinae blocks. Reg Anesth Pain Med. (2023) 48 (9): 437 – 8. doi:10.1136/rapm-2023-104628
  31. 31. Daes J, Morrell DJ, Hanssen A, Caballero M, Luque E, Pantoja R Paragastric autonomic neural blockade to prevent early visceral pain and associated symptoms after laparoscopic sleeve gastrectomy: a randomized clinical trial. Obes Surg. (2022) 32 (11): 3551 – 60. doi:10.1007/s11695-022-06257-9
  32. 32. Bauerle WB, Mody P, Estep A, Stoltzfus J, El Chaar M. Current trends in the utilization of a robotic approach in the field of bariatric surgery. Obes Surg. (2023) 33 (2): 482 – 91. doi:10.1007/s11695-022-06378-1
  33. 33. Gill RS, Al-Adra DP, Birch D, Hudson M, Shi X, Sharma AM Robotic-assisted bariatric surgery: a systematic review. Int J Med Robot. (2011) 7 (3): 249 – 55. doi:10.1002/rcs.400
  34. 34. Fair L, Kruger J, Waddimba A, Baker B, Ogola G, Davis D. Inpatient opioid utilization after robot-assisted versus laparoscopic bariatric surgery. Preprint. Research Square (2024). Available online at: (Accessed May 12, 2025).
  35. 35. Barajas-Gamboa JS, Ihsan Khan MS, Mocanu V, Dang JT, Romero-Velez G, Lee St-John T Pain assessment and analgesic requirements after sleeve gastrectomy: a comparison study of robotic versus laparoscopic approaches. J Clin Med. (2024) 13 (17): 5168. doi:10.3390/jcm13175168
  36. 36. Debel N, Snijkers E, Van De Velde M, Joshi GP, Sauter AR, Freys S Pain management for laparoscopic sleeve gastrectomy: an update of the systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Eur J Anaesthesiol. (2026) 43 (1): 19 – 33. doi:10.1097/EJA.0000000000002296
  37. 37. Hwabejire JO, Kaafarani HMA, Imam AM, Solis CV, Verge J, Sullivan NM Excessively long hospital stays after trauma are not related to the severity of illness: let’s aim to the right target!. JAMA Surg. (2013) 148 (10): 956 – 61. doi:10.1001/jamasurg.2013.2148
  38. 38. Diwan W, Nakonezny PA, Wells J. Effect of length of hospital stay and patient factors on patient satisfaction in an academic hospital. Orthopedics. (2020) 43 (6): 373 – 9. doi:10.3928/01477447-20200910-02
  39. 39. Nijland LMG, De Castro SMM, Van Veen RN. Risk factors associated with prolonged hospital stay and readmission in patients after primary bariatric surgery. Obes Surg. (2020) 30 (6): 2395 – 402. doi:10.1007/s11695-020-04507-2
  40. 40. Bertoch T, D’Aunno D, McCoun J, Solanki D, Taber L, Urban J Suzetrigine, a nonopioid na V 1.8 inhibitor for treatment of moderate-to-severe acute pain: two phase 3 randomized clinical trials. Anesthesiology. (2025) 142 (6): 1085 – 99. doi:10.1097/ALN.0000000000005460

Citation

Yam, J. G., et al. (2026). Erector spinae plane block on post-anesthesia care unit opioid consumption in robotic and laparoscopic sleeve gastrectomy: a retrospective observational single-center cohort analysis. Frontiers in Anesthesiology, Volume 5. https://doi.org/
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5 - 2026

Copyright

© 2026 Yam, Chiang, Barbaranova, Poentis, Hassan, Masrur, Hoang, Shimotake, Bianco, Pavelko, Fettiplace.

License: https://creativecommons.org/licenses/by/4.0/

*Correspondence: Jessalyn Guo-Yee Yam

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