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

Suman Saini; Ananya Sharma; Anju Gupta; Dipankar S. Mankotia; Tankeswar Boruah

doi:10.1055/s-0044-1782506

Journal of Neuroanaesthesiology and Critical Care, Table of Contents

CC BY 4.0 · J Neuroanaesth Crit Care 2024; 11(01): 032-039
DOI: 10.1055/s-0044-1782506

Original Article

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

Suman Saini

¹Department of Anesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

,

Ananya Sharma

¹Department of Anesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

,

Anju Gupta

²Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

,

Dipankar S. Mankotia

³Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital (SJH), Delhi, India

,

Tankeswar Boruah

⁴Central Institute of Orthopedics, Vardhman Mahavir Medical College and Safdarjung Hospital (SJH), Delhi, India

› Author Affiliations

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

Keywords

analgesia - TLIP block - postoperative - spinal fusion - regional anesthesia

Full Text

References

References
1 Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013; 118 (04) 934-944
2 Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth 2015; 62 (02) 203-218
3 Gurbet A, Bekar A, Bilgin H, Korfali G, Yilmazlar S, Tercan M. Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients. Eur Spine J 2008; 17 (09) 1237-1241
4 Nygren J, Thaker J, Carli F. et al. Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg 2013; 37 (02) 285-305
5 Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg 2013; 26 (03) 191-196
6 Qiu Y, Zhang TJ, Hua Z. Erector spinae plane block for lumbar spinal surgery: a systematic review. J Pain Res 2020; 13: 1611-1619
7 Hand WR, Taylor JM, Harvey NR. et al. Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Can J Anaesth 2015; 62 (11) 1196-1200
8 Chen K, Wang L, Ning M, Dou L, Li W, Li Y. Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial. PeerJ 2019; 7: e7967
9 Ammar MA, Taeimah M. Evaluation of thoracolumbar interfascial plane block for postoperative analgesia after herniated lumbar disc surgery: a randomized clinical trial. Saudi J Anaesth 2018; 12 (04) 559-564
10 Hu Z, Han J, Jiao B. et al. Efficacy of thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine surgery: a meta-analysis of randomized clinical trials. Pain Physician 2021; 24 (07) E1085-E1097
11 Wengritzky R, Mettho T, Myles PS, Burke J, Kakos A. Development and validation of a postoperative nausea and vomiting intensity scale. Br J Anaesth 2010; 104 (02) 158-166
12 Sullivan GM, Artino Jr AR. Analyzing and interpreting data from Likert-type scales. J Grad Med Educ 2013; 5 (04) 541-542
13 Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135
14 Ozmen O, Ince I, Aksoy M, Dostbil A, Atalay C, Kasali K. The effect of the modified thoracolumbar interfacial nerve plane block on postoperative analgesia and healing quality in patients undergoing lumbar disk surgery: a prospective, randomized study. Medeniyet Med J 2019; 34 (04) 340-345
15 Wang L, Wu Y, Dou L, Chen K, Liu Y, Li Y. 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. Pain Ther 2021; 10 (02) 1331-1341
16 Morgenstern C, Ramírez-Paesano C, Juanola Galcerán A, Morgenstern R. Thoracolumbar interfascial plane block results in opioid-free postoperative recovery after percutaneous/endoscopic transforaminal lumbar interbody fusion surgery. World Neurosurg 2021; 153: e473-e480
17 Bernard JM, Surbled M, Lagarde D, Trennec A. [Analgesia after surgery of the spine in adults and adolescents]. Cah Anesthesiol 1995; 43 (06) 557-564
18 Bajwa SJ, Haldar R. Pain management following spinal surgeries: an appraisal of the available options. J Craniovertebr Junction Spine 2015; 6 (03) 105-110