Thoracolumbar Interfascial Plane Block (TLIP) Modified Technique for Lumbar Decompression Surgery in Cirrhotic Hepatic Patients with Thrombocytopenia: A Case Report

Abstract

Introduction: As one of the top ranks in the pain-producing procedure, spinal surgery requires adequate perioperative pain management to improve outcomes. Likewise, perioperative pain management in cirrhotic hepatic thrombocytopenia patients is challenging. Modified TLIP block can be an option for perioperative pain management in the lumbar decompression surgery for a cirrhotic hepatic patient with thrombocytopenia. Case Presentation: A man, 67 years old, who suffered from cirrhosis hepatic with thrombocytopenia underwent endoscopic spinal decompression with laminotomy and flavectomy of L4-L5. After induction of general anesthesia with midazolam 1,5 mg, fentanyl 150 mcg, propofol 100 mg, and rocuronium 1mg/kg, the patient was intubated. The lungs were ventilated with a pressure control mode with tidal volume 8 ml/kg BW, respiratory rate 12/min, and PEEP 5 cm H2O with FiO2 50%. and 1% sevoflurane. Modified TLIP block was performed at the L3 level. Twenty ml of bupivacaine 0,5% was administered between the longissimus and iliocostalis muscles on both sides. Results: Intraoperative, modified TLIP block provide adequate analgesia with stable hemodynamics. The visual Analog Scale (VAS) of pain was 1-2 in 24h postoperative. No additional opioid was required within 24 hours postoperatively. There were no neurological complications or bleeding due to the modified TLIP block found in this patient. Conclusion: Modified TLIP block can be an effective and safe analgesic technique for hepatic cirrhosis patients with thrombocytopenia. However, further research is needed to determine the safety limits of modified TLIP block in patients with coagulation disorder or anticoagulant use.