Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial

  • Mohammad FathyEmail author
  • Mohamed Anwar Abdel-Razik
  • Ayman Elshobaky
  • Sameh Hany Emile
  • Ghada El-Rahmawy
  • Ahmed Farid
  • Hosam Ghazy Elbanna
Original Contributions



One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG.


Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively.


Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001).


Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate.


Sleeve gastrectomy Pyloric injection Magnesium sulfate, lidocaine Early outcome Randomized trial 


Authors’ Contributions

Hosam Elbanna and Mohammad Fathy designed the study. Mohammad Fathy, Mohamed Abdel-Razik, Ayman Elshobaky, and Hosam Elbanna performed the surgical procedures, followed the patients, and shared in data analysis and writing of the manuscript. Ghada El-Rahmawy and Ahmed Farid contributed to study design, collection and interpretation of data, and revising the manuscript. Sameh Emile contributed to data analysis and interpretation, writing and revising of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

No conflict of interests or financial ties to be declared by the authors.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

This study was conducted in accordance with the declaration of Helsinki. Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Mansoura Faculty of Medicine.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department General Surgery, Mansoura University HospitalsMansoura UniversityMansouraEgypt
  2. 2.Anesthesiology Department, Mansoura University HospitalsMansoura UniversityMansouraEgypt

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