Multimodal anesthesia and continuous thoracolumbar fascia block technique for analgesia in major spinal surgery

Abstract

Objectives: Spinal surgical procedures, including posterior lumbar interbody fusion and oncological spinal surgery, are associated with severe acute and chronic postoperative pain. Therefore, adequate perioperative pain management is essential in order to enhance early functional outcome and prevent chronic pain. However, the use of loco regional anaesthesia techniques still seems controversial as hard evidence is lacking. In this specific type of surgery, anesthesia management consists of multimodal (low opioid) anaesthesia and wound infiltration with local anesthetics. Recently, we expanded the described anesthesia approach with continuous administration of local anesthetics administered under the posterior thoracolumbar fascia (TLF block) which resulted in improved analgesia, reduction of opioid use and earlier mobilization. A case series of this technique is described.