Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial.

Ke Chen,Yuanhai Li,Lianjie Dou,Lizhen Wang,Meng Ning,Wei Li

doi:10.7717/peerj.7967

Abstract

ObjectiveUltrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery.MethodsA prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively.ResultsOpioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups.ConclusionOur study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

Highlights

Posterior lumbar spinal fusion surgery, an effective method to limit the progression of deformity (Weinstein et al, 2008), has increased by 65% in the past 20 years (Rushton et al, 2018)
Patients were excluded from the study if they met any of the following criteria: abnormal liver and kidney function, psychiatric disorders or use of psychiatric medications, use of anticoagulants or corticosteroids, bleeding diathesis, or a known allergy to local anesthetics
Height, weight, ASA, body mass index (BMI), and surgical and anesthesia times showed no significant difference between the two groups (Table 1)

Summary

Introduction

Posterior lumbar spinal fusion surgery, an effective method to limit the progression of deformity (Weinstein et al, 2008), has increased by 65% in the past 20 years (Rushton et al, 2018). This type of surgery brings about greater relief than classic conservative treatment (Yoshihara, 2012). There are many methods for pain control, including intravenous opioids, nonsteroidal anti-inflammatory agents, local anesthetic (LA) infiltration of incision sites, and regional analgesia. Each of these analgesic techniques possesses inherent advantages and disadvantages that restricts their universal applicability. Multimodal analgesia for proper control of pain appears to be the best strategy for pain management (Bajwa & Haldar, 2015)

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Conclusion