Thoracolumbar Interfascial Plane Block Research Articles

Analgesic Efficacy of Thoracolumbar Interfascial Plane Block versus Standard Care in Patients Undergoing Lumbar Spinal Surgeries—A Randomized Controlled Trial

Abstract Background Patients who undergo spine surgery often experience severe pain postoperatively. Multimodal analgesia inclusive of a regional block provides optimal pain relief. Thoracolumbar interfascial plane (TLIP) block may provide promising analgesia in these patients. Materials Fifty consenting adults aged between 18 and 60 years undergoing elective lumbar spinal surgeries under balanced general anesthesia were divided into two equal groups (group T: received bilateral TLIP block, and group C: received conventional opioid analgesia). All the patients were taken care of by an independent anesthesiologist unaware of the study protocol in the postanesthesia care unit. The postoperative pain was assessed by visual analog scale (VAS). Time to first rescue analgesia, total morphine consumption, complications, and patient satisfaction were also recorded. Results Postoperative mean VAS scores till 12 hours were significantly higher in the control group. The mean time to the first analgesic requirement among group T and group C patients was 404.4 ± 25.1 and 150.2 ± 12.4 minutes, respectively (p < 0.001). Morphine consumptions in 24 hours were also significantly higher in group C (3.36 ± 1.04 vs. 7.84 ± 1.43; p < 0.001). Mean intraoperative fentanyl consumption was significantly more in group C (122.4 ± 16.4 µg and 140.4 ± 21.7 µg; p = 0.001). Complications were similar in both groups. However, patient satisfaction was significantly higher in group T (p < 0.001). Conclusion TLIP block provided superior analgesia, decreased opioid consumption, and improved patient satisfaction as compared with patients receiving standard general anesthesia with opioid analgesics. Hence, TLIP block could be a component of multimodal analgesia in patients undergoing lumbar spine surgeries.CTRI No.: CTRI/2021/03/031682

Exploring the Thoracolumbar Interfascial Plane (TLIP) Block as a Novel Approach for Improved Pain Management After Spine Surgery: A Comparative Review

Exploring the Thoracolumbar Interfascial Plane (TLIP) Block as a Novel Approach for Improved Pain Management After Spine Surgery: A Comparative Review

Analgesic efficacy of classical thoracolumbar interfascial plane block versus modified thoracolumbar interfascial plane block in patients undergoing lumbar disc surgeries: A comparative, randomised controlled trial.

We compared classical (medial) and modified (lateral) thoracolumbar interfascial plane block (TLIP) with only general anaesthesia (GA) using multimodal analgesia in patients undergoing lumbar disc surgeries. In this study, 100 patients aged 18-70 years were randomised to Group cTLIP (conventional TLIP block with 20 mL of 0.25% ropivacaine with GA), Group mTLIP (modified TLIP block with 20 mL of 0.25% ropivacaine with GA), and Group C (only GA using multimodal analgesia). The primary outcome was to assess the total peri-operative opioid consumption in the first 24 h. The secondary outcomes were to assess pain score upon arriving in the post-anaesthesia care unit, time to first analgesic need after surgery, post-operative opioid consumption in 24 h, and incidence of nausea and vomiting. The total peri-operative opioid consumption in Group cTLIP (507.58 (258.55) μg) and Group mTLIP (491.67 (165.39) μg) was significantly lower than that in Group C (1225.4 (237.03) μg); (P < 0.001). However, it was comparable between groups cTLIP and mTLIP (P = 0.767). Pain score was comparable in groups cTLIP and mTLIP. It was significantly lower than Group C (P = 0.001). Rescue analgesia was needed in all (100%) patients of Group C but in only 15.2% of patients of the cTLIP and mTLIP groups. No patient in groups cTLIP and mTLIP complained of nausea and vomiting in the first 24 h, whereas it was significantly higher (61.8%) in Group C (P = 0.001). The analgesic effect of the modified TLIP block was not superior to the conventional TLIP block. Both techniques provided the same intra-operative and post-operative analgesia for lumbar disc surgeries.

Efficacy and Safety of Erector Spinae Plane Block Versus Thoracolumbar Interfascial Plane Block in Patients Undergoing Spine Surgery: A Systematic Review and Meta-analysis.

As 2 novel peripheral nerve blocks, the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block can relieve postoperative pain in spinal surgery. This systematic review and meta-analysis aimed to determine the efficacy and safety of ESPB versus TLIP block in patients undergoing spine surgery. An extensive search of English online databases, including PubMed, Web of Sciences, Embase, Medline, and Cochrane Central Register of Controlled Trials, and Chinese online databases like Wanfang Data, CNKI, and CQVIP until March 31, 2023, with no language restrictions, was performed. This systematic review and meta-analysis are based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and have been registered on PROSPERO (International Prospective Register of Systematic Reviews) with registered ID: CRD42023420987. Five studies involving 457 patients were eligible for inclusion in this study. Compared with TLIP block, ESPB had lower postoperative opioid consumption at postoperative 48 hours (standard mean difference =-1.31, 95% CI:-2.54 to -0.08, P =0.04, I2 =80%) and postoperative pain score at postoperative 24 hours (standard mean difference =-0.72, 95% CI=-1.43 to -0.02, P =0.04, I2 =95%) in patients undergoing spine surgery. Complications associated with ESPB and TLIP block were not reported in the included studies. ESPB and TLIP block are 2 novel and effective block methods. Patients receiving ESPB had lower postoperative opioid consumption and postoperative pain scores compared with patients receiving TLIP block; there was no statistically significant difference's between the 2 groups in intraoperative opioid consumption, adverse events, and rescue analgesia.

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Introduction: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. Methods: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients’ 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. Results: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p &gt; 0.05). Conclusions: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

Ultrasound-Guided Thoracolumbar Interfascial Plane Block with and Without Dexamethasone: A Comparative Study in Patients Undergoing Lumbar Spine Surgeries

ABSTRACT Background: Thoracolumbar interfascial plane (TLIP) block is a novel regional anesthetic technique that can provide effective postoperative analgesia in patients undergoing lumbar spine surgeries. This block targets the dorsal rami of thoracolumbar nerves as they pass through the paraspinal muscles. Multilevel spine surgeries are often prolonged, requiring extended duration of postoperative analgesia. Objective: To compare the duration and quality of postoperative analgesia of TLIP block when given with and without dexamethasone as an additive to bupivacaine. Methodology: This was a prospective, double-blinded randomized study done on 20 patients undergoing two- or three-level lumbar spine surgeries. Ten patients in group C received 20 ml of 0.25% bupivacaine alone, whereas 10 patients in Group D received 8 mg dexamethasone along with 20 ml of bupivacaine for TLIP block before skin incision. Time for first analgesic request and pain scores using Wong–Baker Faces Pain Rating Scale were measured postoperatively. Results: The mean duration of sensory block was longer in group D when compared to group C (502.00 ± 95.13 vs. 383.5 ± 54.53 min with a P value of 0.001). The amount of rescue analgesic requirement was also higher in group C compared to group D. Conclusion: Dexamethasone, as an additive to bupivacaine, prolongs the duration and improves the quality of TLIP block for lumbar spine surgeries.

Regional analgesia techniques for lumbar spine surgery: A frequentist network meta-analysis.

Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing lumbar spine surgery. Traditionally, wound infiltration (WI) with local anesthetics has been widely used by surgeons. Recently, other regional analgesia techniques, such as the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block, are being used for multimodal analgesia. We aimed to determine the relative efficacy of these using a network meta-analysis (NMA). We searched PubMed, EMBASE, the Cochrane Controlled Library, and Google Scholar databases to identify all randomized controlled trials (RCT) that compared the analgesic efficacy of the following interventions: erector spinae plane block (ESPB), thoracolumbar interfascial plane (TLIP) block, wound infiltration (WI) technique and controls. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery while pain score, estimated postoperatively at three different time periods, was the secondary objective. We included 34 RCTs with data from 2365 patients. TLIP showed the greatest reduction in opioid consumption compared to controls (mean difference (MD) =-15.0mg; 95% CI, -18.8 to -11.2). In pain scores TLIP had the greatest effect during all time periods compared to controls (MD =-1.9 in early, -1.4 in middle, -0.9 in late). The injection level of ESPB was different in each study. When only surgical site injection of ESPB was included in the NMA, there was no difference compared with TLIP (MD =1.0mg; 95% CI, -3.6 to 5.6). TLIP showed the greatest analgesic efficacy after lumbar spine surgery, in terms of postoperative opioid consumption and pain scores, while ESPB and WI are also alternative analgesic options for these surgeries. However, further studies are needed to determine the optimal method of providing regional analgesia after lumbar spine surgery.

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial

Background and objectivesThe erector spinae plane block (ESPB) and classical thoracolumbar interfascial plane (TLIP) block can reduce postoperative pain in lumbar surgery. In this study, we compared the efficacy of ESPB and classical TLIP block in providing perioperative analgesia in patients undergoing lumbar posterior decompression and stabilization by comparing postoperative pain, opioid consumption, and IL-6 and IL-10 serum concentrations between ESPB and classical TLIP block.MethodThis was a prospective, double-blinded, randomized controlled trial in tertiary referral hospitals. Forty patients were randomized into two equal groups, each receiving either ESPB or classical TLIP block. The primary outcome was the difference in IL-6 and IL-10 serum concentrations at baseline and 6 h after lumbar posterior decompression and stabilization. The secondary outcome was total opioid consumption and pain score 24 h post-operatively.ResultThere were no significant differences between the ESPB and classical TLIP block groups in pain score, IL-6 and IL-10 concentration change, and total opioid consumption post-operatively. There was a significant difference in the time until the first dose of morphine was needed between the ESPB and classical TLIP block groups (300 min vs. 547.5 min; p = 0.002).ConclusionESPB and classical TLIP block performance during lumbar surgery have comparable pain scores, IL-6 and IL-10 concentration differences pre- and post-operation, and total opioid consumption post-operatively. However, classical TLIP block provides a prolonged duration of analgesia.Trial registrationClinicalTrials.gov NCT04951024.

Paraspinal regional analgesic techniques in spine surgery−a narrative review

Patients undergoing spine surgeries may experience intense postoperative pain and its related complications such as increased opioid use and delayed early ambulation. Therefore, adequate perioperative pain management is important to promote patient’s recovery. In addition, many patients often present with pre-existing chronic pain and opioid use. Although regional analgesic techniques are widely used in other surgical fields, the use of this modality for spine surgery is still evolving. This review article discusses the use of regional analgesic techniques for pain management during spine surgeries. Specifically, we will review fascial plane blocks including erector spinae plane block, retrolaminar block, transversus abdominis plane block, thoracolumbar interfascial plane block, modified thoracolumbar interfascial plane block, multifidus cervicis plane block, and superficial cervical plexus block. In addition, the use of liposomal bupivacaine is discussed. Regional analgesic techniques are described as part of multimodal analgesia regimens and show promising analgesic effects and favorable outcomes in spine surgery. However, the results from the most recent articles revealed only a short-term and limited benefit. Further well-designed studies with greater sample sizes are needed to clarify the effects of regional analgesic techniques on perioperative pain management, including long-term benefits.

Associations with daily opioid use during hospitalization following lumbar fusion: A contemporary cohort study

BackgroundPredicting opioid use after lumbar spine fusion remains a challenge. The aim of this study was to identify clinical and demographic parameters that could be associated with opioid use trends during hospitalization after lumbar spine fusion. MethodsA cohort study of prospective data for all lumbar fusions performed by single surgeon for an 18-month period from 2019 to 2020 was conducted. Univariable and multivariable linear regression analyses were used to assess associations. ResultsAmongst the overall cohort of 136 lumbar fusion patients, the mean age was 66.1 ± 10 years, there was an average of 1.7 ± levels treated. Overall, mean opioid use for total stay was 276 ± 360 morphine milligram equivalents (MME), with the greatest amount on postoperative day 1 (POD1) with 81.6 ± 86 MME. Multivariable linear analysis identified older age (−9.9 MME/year; P < 0.01), male gender (−130 MME; P = 0.03) and thoracolumbar interfascial plane (TLIP) block (−144 MME; P = 0.02) all independently were associated with significantly lower opioid use during overall hospitalization. Older age (P < 0.01), POD1 pain in back (P < 0.01), and TLIP use (P < 0.02) also independently were associated significantly lower opioid use on POD1. ConclusionsSignificant reductions in opioid use during hospitalization after lumbar spine fusion were associated with patients that were older, male, and had a TLIP block used. The maximum absolute opioid use was on POD1. We were able to quantify these trends on a daily gradient, which lays the conceptual groundwork to develop personalized algorithms which can model opioid use during hospitalization prior to surgery.

75. Opioid-free and awake TLIF surgery with a novel interfascial block

<h3>BACKGROUND CONTEXT</h3> Despite a significant rise in prescription opioid-related overdose deaths in the last decade and the US Department of Health declaring the opioid epidemic a national emergency in 2017, median opioid prescription duration remains the longest for spine surgery with 12.6 days, prompting a demand for alternatives to opioid medication in spine surgery-related analgesia. Thoraco-lumbar interfascial plane (TLIP) block [10, 11] is an ultrasound-guided interfascial block that has shown promising results in reducing opioid consumption in non-instrumented spine surgery procedures. <h3>PURPOSE</h3> The aim of this study was to evaluate the efficacy in reducing postoperative pain and opioid analgesia of a novel interdisciplinary strategy combining preoperative thoraco-lumbar interfascial plane (TLIP) block and instrumented percutaneous/endoscopic TLIF surgery. Secondary aims were to determine the time to first postoperative ambulation and hospital length of stay. <h3>STUDY DESIGN/SETTING</h3> This is a prospective study with a retrospective control cohort. <h3>PATIENT SAMPLE</h3> Forty-two patients who underwent elective single-level percutaneous/endoscopic TLIF surgery between 2015 and 2021. A TLIP group with 17 patients prospectively underwent TLIP block before surgery and non-TLIP (control) group with 25 patients obtained standard opioid analgesia. Both groups received the same postoperative analgesia with morphine as patient-controlled rescue medication. <h3>OUTCOME MEASURES</h3> Visual analogic scale (VAS) and Oswestry Disability Index (ODI) scores were evaluated. Statistical evaluation was performed with Student's t-test. <h3>METHODS</h3> For the TLIP group, ultrasound-guided bilateral TLIP was performed in prone position with bupivacaine 0.25% and dexamethasone 8mgrs (20 ml each side) by the anesthesia team. All patients were operated on under general anesthesia (protocol: propofol 2.0-3.0 mcg/ml (TCI) following BIS, ketamine 0.15 mg/Kg/h, rocuronium 0.4 mg/Kg). Percutaneous TLIF was performed by inserting an expandable interbody implant using the facet-sparing, trans-Kambin approach with an endoscopic cannula and complemented with a percutaneous posterior fixation consisting of transpedicular screws and rods. Postoperative analgesia included NSAIDs and acetaminophen. intravenous morphine was administered with a PCA pump consisting of a bolus of 20mcg/kg with interval lock-out of 15 minutes and a maximum of 3 bolus per hour. The use of the PCA pump was monitored. <h3>RESULTS</h3> In contrast to the non-TLIP group, the TLIP group's postoperative, mean VAS back scores as well as mean ODI significantly decreased from 6.6 to 3.3 (P <0.01) and 32.8 to 23.6 (P <0.01) at hospital discharge. No differences were found between both groups at one month. The overall mean follow-up was 29±18 (3–78) months. Non-TLIP group patients were administered a median postoperative 24-hour morphine dose equivalent (MDE) of 23 (range, 8-31) mgr, while TLIP group patients did not require opioid analgesia (P <0.01). TLIP Group patients started postoperative ambulation at a median of 4.1 (range, 2.5–26) hours with a median hospital length-of-stay of 24 [range, 20–48] hours (P=0.112). <h3>CONCLUSIONS</h3> TLIP block significantly improves patient outcome at hospital discharge after TLIF surgery without postoperative administration of opioids. A prospective study is recommended to confirm our preliminary results. <h3>FDA DEVICE/DRUG STATUS</h3> Globus Rise (Approved for this indication), Bupivacaine (Approved for this indication)

Ultrasound-guided fascial plane blocks for spine surgery.

The development of truncal and fascial plane blocks has created novel opportunities to apply regional analgesic techniques to patients undergoing spine surgery. This review will summarize recent literature devoted to evaluating candidate blocks for spine surgery, including erector spinae plane block, thoracolumbar interfascial plane block, midpoint transverse process to pleura block, and transversus abdominis plane block. Procedure-specific effects of blocks on patient and healthcare system outcomes will be presented and gaps in care and knowledge will be highlighted. The most studied paradigm was bilateral erector spinae plane block for lumbar spine surgery. The most common outcomes assessed were early postoperative pain scores, opioid consumption and related side effects, and length of hospital stay. All candidate blocks were associated with mixed evidence for analgesic and opioid-sparing benefits, and/or reductions in length of hospital stay. The magnitude of these effects was overall small, with many studies showing statistically but not clinically significant differences on outcomes of interest. This may reflect, at least in part, the current state of the (emerging) evidence base on this topic. Our understanding of the risks, benefits, and value of truncal and fascial plane blocks for spine surgery cohorts is evolving. Although the results derived from this body of literature are encouraging, further research is required before the widespread adoption of specified blocks into spine care can be recommended.

Comparing the Effect of Classical and Modified Thoracolumbar Interfascial Plane Block on Postoperative Pain and IL-6 Level in Posterior Lumbar Decompression and Stabilization Surgery

BackgroundUltrasound (US)-guided classical and modified thoracolumbar interfascial plane (TLIP) blocks are often used to provide adequate analgesia after lumbar spinal surgery. Postoperative pro-inflammatory interleukin 6 (IL-6) blood concentrations after lumbar spine surgery are related to postoperative pain and inflammation.ObjectivesThe purpose of this prospective randomized parallel controlled study was to assess postoperative pain and serum levels of pro-inflammatory IL-6 after posterior lumbar decompression and stabilization surgery with a classical and modified technique of TLIP block.MethodsThis prospective randomized, single-blinded controlled pilot study was conducted on eight patients who will undergo posterior lumbar decompression and stabilization surgery. After obtaining the ethical approval and an informed consent, all subjects were randomly allocated into the classic TLIP group and the modified TLIP group. Following general anesthesia induction, 20 mL bupivacaine 0.25% was injected on each side in interfascialis plane between m. longissimus and m. iliocostalis in modified TLIP group and between m. multifidus and m. longissimus in classical TLIP group. Intraoperative hemodynamic (blood pressure and heart rate) and noxious stimulation response level (qNOX), postoperative IL-6 level, 24-hour morphine consumption, and numerical rating score were recorded and analyzed.ResultsThe median of IL-6 level was found to be lower in the modified TLIP group 12 hours postoperatively compared to classic TLIP (29.91 (8.56 – 87.61) vs. 46.87 (2.87 – 92.35)). The mean Numerical Rating Scale (NRS) in the modified TLIP block was comparable with the classic TLIP group, although it was lower than the classic TLIP group (2.75 ± 1.5 vs. 3.75 ± 1.7 at 6 hours and 3.5 ± 1.3 vs. 4 ± 1.6 12 hours postoperatively). However, there was no difference in intraoperative hemodynamic, Qnox value, and total postoperative morphine consumption between the two groups.ConclusionsOur study showed that modified TLIP block resulted in lower IL-6 level and NRS 12 hours postoperatively compared to classical TLIP block. However, there were no differences in total postoperative morphine consumption between the two groups.

434 Reduced Postoperative Narcotics Consumption With Intraoperative Thoracolumbar Interfascial Plane (TLIP) Block Compared to Traditional Field Block

INTRODUCTION: Given the increasing burden of narcotics usage, spine surgeons have adopted several innovative methods to reduce postoperative pain and narcotics consumption. Local infiltrative anesthetics are commonly administered intraoperatively to provide a local field block for several days after surgery. However, these blocks are limited to the areas in which the anesthetic is injected and is technique-dependent. METHODS: A retrospective review of a single surgeon, single institution series of adult patients was conducted between July 2019 and November 2020. Patients were divided into the TLIP or Traditional group depending on which infiltration technique was used. All patients underwent thoracolumbar fusion. Baseline and demographic characteristics and daily narcotics consumption were collected for each patient. All opioid amounts were converted into morphine milligram equivalents (MMEs) for standardization. Analyses were conducted using chi-square exact test and Wilcoxon rank-sum test for categorical and continuous data, respectively. RESULTS: A total of 136 patients were included. Sixty-four (47%) and 72 (53%) managed by TLIP and traditional approaches respectively. Overall mean age was 66.1 years (range, 26-85) with 63 (46%) males and 73 (54%) females, with no significant difference between groups. TLIP patients on average required less hydromorphone than Traditional patients on POD1 (25.1 vs 58.1 mg, P = 0.03) and overall (99.2 vs 184 mg, P = 0.04), less diazepam overall (4.1 vs 10.4 mg, P = 0.01) and less overall opioid medication on POD1 (65.9 vs 95.6 MME, P = 0.04) and overall (221 vs 325 MME, P = 0.03). There was no statistical difference in Percocet use, or any opioid. medications on POD0. TLIP patients experienced shorter length of stay compared to the Traditional group although this difference did not achieve significance (3.0 vs 3.6, P = 0.28). Complication rates were comparable between groups. CONCLUSION: TLIP patients required less hydromorphone and diazepam, as well as total narcotics during their hospital stay, indicating that on average they experienced less severe pain and muscle spasms postoperatively.

Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries - A prospective double-blinded randomised controlled trial.

ABSTRACTBackground and Aims:Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic.Methods:Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically.Results:The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001.Conclusion:TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic.

Effect of Ultrasound-Guided Thoracolumbar Interfascial Plane Block on the Analgesic Requirements in Patients Undergoing Lumbar Spine Surgery Under General Anesthesia: A Randomized Controlled Trial.

BackgroundThoracolumbar interfascial plane (TLIP) block was recently described as a regional anesthetic technique to achieve analgesia for lumbar spine surgery by blocking the dorsal rami of spinal nerves. The study aims to test the hypothesis that TLIP block can offer pain control and reduce the perioperative analgesic requirement in patients undergoing spinal surgery.MethodsThere were 60 patients scheduled for lumbar spine surgery who were randomly assigned into two equal groups, TLIP and control groups. Patients in the TLIP group received general anesthesia and TLIP block while patients in the control group received general anesthesia alone. The primary outcome was the analgesic consumption in the first postoperative 24 hours, while intraoperative additional analgesic needs, time to the first request of postoperative analgesia, and pain scores were the secondary outcomes.ResultsAt 24 hours postoperatively, morphine consumption was lower in the TLIP group (5.13±1.55) versus the control group (14.33±2.58) mg. The intraoperative fentanyl consumption was lower in the TLIP group (15±35.11 mcgs) versus the control group (105±62.08 mcgs). Postoperative first request for analgesia was delayed in the TLIP group (7.30±2.69 h) compared to the control group (0.92±1.23 h). Postoperative Pain scores at rest were 2.53 ± 0.97 and 3.43 ± 0.50 at 24 hours in the TLIP group and the control group, respectively. Postoperative Pain scores at passive flexion of spine were 2.73 ±0.87 and 3.93 ±0.78 at 24 hours in the TLIP group and the control group, respectively. Patients in the TLIP group had lower perioperative hemodynamic responses to surgical stimulation in comparison to the control group.ConclusionCombined TLIP block with general anesthesia in patients undergoing spinal surgery reduced both postoperative and intraoperative analgesic needs, reduced intra-operative hemodynamic response to surgery, and achieved good postoperative pain control.

Comparison of Two Ultrasound-guided Plane Blocks for Pain and Postoperative Opioid Requirement in Lumbar Spine Fusion Surgery: A Prospective, Randomized, and Controlled Clinical Trial.

IntroductionThe erector spinae plane (ESP) block and thoracolumbar interfascial plane (TLIP) block were two novel plane blocks. The purpose of this study was to investigate TLIP block and ESP block on the effect of analgesic and opioid consumption in lumbar spine fusion surgery in the perioperative period.MethodsThree hundred and four patients who suffered lumbar spine fusion were included and randomly divided into three groups: a control group (n = 102), an ESP block group (n = 100), and a TLIP block group (n = 102). We recorded the numerical rating scale (NRS) pain at movement and static during the postoperative 48 h, opioid consumption, additional analgesic requirement, frequency of patient-controlled analgesia (PCA) compressions, Bruggemann Comfort Scale (BCS) score, side effects, duration of hospital stay, and the life quality score (LQS) after operation at 6 months.ResultsThe patients in the ESP block group have better analgesia during 12–48 h postoperative time at static state, a lower frequency of PCA compressions at 24–48 h after surgery, and the opioid consumption in the PCA (sufentanil) were less than those in the TLIP block group (P < 0.05). However, the BCS and LQS scores were no different between the two plane block groups after surgery at 6 months. There was no difference in hospital stay and the incidence of side effect among the three groups.ConclusionsOur results found that patients who suffered ESP block have better analgesic effects and less pain scores in static states and less frequency of PCA compression and opioid analgesic consumption compared with those that suffered TLIP block.Trial RegistrationChiCTR1800019639.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00295-4.

Thoracolumbar Interfascial Plane Block Results in Opioid-Free Postoperative Recovery After Percutaneous/Endoscopic Transforaminal Lumbar Interbody Fusion Surgery

To evaluate efficacy in reducing postoperative pain and opioid analgesia of a novel interdisciplinary strategy combining preoperative thoracolumbar interfascial plane (TLIP) block and percutaneous/endoscopic transforaminal lumbar interbody fusion surgery and to determine time to first postoperative ambulation and hospital length of stay. In this retrospective review, 42 patients who underwent elective single-level percutaneous/endoscopic transforaminal lumbar interbody fusion surgery between 2015 and 2021 were divided into 2 groups: TLIP group with 17 patients who underwent TLIP block and non-TLIP group with 25 patients. Both groups received the same postoperative analgesia with morphine as patient-controlled rescue medication. Visual analog scale and Oswestry Disability Index scores were evaluated. Statistical evaluation was performed with Student t test. In contrast to the non-TLIP group, in the TLIP group, postoperative mean visual analog scale back score and mean Oswestry Disability Index score significantly decreased from 6.6 to 3.3 (P < 0.01) and 32.8 to 23.6 (P < 0.01), respectively, at hospital discharge. No differences were found between the groups at 1 month. Overall mean follow-up time was 29 ± 18 months (range, 3-78 months). Patients in the non-TLIP group were administered a median postoperative 24-hour morphine dose equivalent of 23 mg (range, 8-31 mg), while patients in the TLIP group did not require opioid analgesia (P < 0.01). Patients in the TLIP group started postoperative ambulation at a median of 4.1 hours (range, 2.5-26 hours) with a median hospital length of stay of 24 hours (range, 20-48 hours) (P= 0.112). TLIP block significantly improves patient outcome at hospital discharge after transforaminal lumbar interbody fusion surgery without postoperative administration of opioids. A prospective study is recommended to confirm our preliminary results.

Clinical efficacy of ultrasound guided bilateral erector spinae block for single-level lumbar fusion surgery: a prospective, randomized, case-control study

BACKGROUND CONTEXTPostoperative experience plays a vital role in patient recovery and does not depend on the type and quality of the surgical procedure alone. Non-opioid therapies have become part of the multimodal analgesic regimen for better pain control and reduced opioid-related side effects. Most recently evolved among these are the regional anesthetic techniques, such as the thoracolumbar interfascial plane (TLIP) block and the erector spinae (ESP) block. PURPOSETo assess the efficacy of ultrasound-guided (US) ESP block for postoperative analgesia after a single level lumbar spine fusion surgery compared with conventional (opioid-based) multimodal postoperative analgesia. STUDY DESIGNA prospective, randomized, controlled, and double-blinded clinical trial. PATIENT SAMPLEA 100 consecutive patients requiring single-level lumbar spinal fusion procedure were randomized into two groups- block (multimodal analgesia with US-ESP) and control (only multimodal analgesia) groups. OUTCOME MEASURESDemographic and surgical data, intra-operative blood loss, duration of surgery, total opioid consumption (TOC) and amount of muscle relaxants used were assessed. Postoperatively, the Numeric pain Rating Scale(NRS), Modified Observer's assessment of Alertness and/or Sedation Scale (MOASS) and Patient satisfaction scores were recorded every 2 hours for the first 6 hours followed by every 6 hours for 24 hours. Continuous variables were analyzed using Student's t-test, and categorical variables were analyzed using either the Chi-square test or Fisher's exact test. p-value < .05 was considered statistically significant. METHODSPatients in both groups underwent the identical protocol for pre-emptive analgesia and induction of anesthesia. Patients in the block group received the US-ESP block after induction and positioning, followed by the multimodal analgesia, while the control group received only the multimodal analgesia. RESULTSBoth groups had identical demographic backgrounds and surgical profile. TOC for 24 hours following induction was significantly lower in the block group than the control group (105.0 ± 15.15 vs 158.00 ± 23.38mcg; p < .001). The total muscle relaxant consumption during surgery was also significantly less in the block group than the control group (51.90 ± 3.17 vs 57.70 ± 5.90; p < .001). The intra-operative blood loss was significantly less (p < .001) in the block group (303.00 ± 86.55 ml) than the control group (437.00 ± 116.85 ml). Compared to the block group, the control group's pain score (NRS) was significantly higher in the first 48 hours following surgery. The MOASS score was significantly lower in the control group (4.46 ± 0.50 vs 3.82 ± 0.82; p < .001) in the immediate postoperative period. The satisfaction score was significantly higher in the block group than the control group (9.52 ± 0.65 vs 8.22 ± 0.79; p < .001). CONCLUSIONThe employed US-ESP block for single-level lumbar fusion surgery is an effective component of multimodal analgesia for reducing blood loss, total opioid consumption, and related side effects with a significant reduction of postoperative pain and higher patient satisfaction.