Balanced general anesthesia, even if combined with local anesthesia or parietal blocks such as transversus abdominis plane, subcostal, or pararectal blocks, is often insufficient to block the autonomic impulses released during most intra-abdominal visceral surgeries, especially in laparoscopic sleeve gastrectomy (LSG). These impulses are responsible in part for the hemodynamic changes observed during different phases of LSG and the subsequent visceral pain and associated symptoms, such as nausea and vomiting, observed in a substantial number of patients in the immediate postoperative period after LSG and other minimally invasive procedures. Visceral pain substantially impacts the patient’s quality of life, recovery time, nursing time allocation, and resultant risk of opioid use, dependence, and abuse. Nausea, food intolerance, and pain are responsible for most readmissions after LSG and other bariatric procedures. Our initial randomized clinical trial (RCT) demonstrated that a novel approach, namely paragastric autonomic neural blockade, is safe and effective in addressing visceral pain while reducing the need for analgesics (including opioids) and decreasing the incidence of nausea and vomiting in the first 24 hours after LSG. A more recent RCT found that by performing the autonomic neural blockade as the first step in LSG, the need for remifentanil and halogenated anesthetics diminished significantly, and hemodynamic stability increased while maintaining the previously reported reduction of postoperative visceral pain and associated symptoms. Combining bupivacaine with clonidine, liposomal bupivacaine, or dexamethasone with and without colloids has increased the duration of the ANB effect. When implementing a variation of the autonomic blockade targeting proper pathways in cholecystectomy, colectomies, and hysterectomies, the same benefits described have been observed.