Thoracolumbar interfascial plane block for postoperative analgesia in spine surgery: A systematic review and meta-analysis

Yu Ye, Yaodan Bi, Jun Ma, Bin Liu, Yu Ye, Yaodan Bi, Jun Ma, Bin Liu

Abstract

Introduction: Thoracolumbar interfascial plane (TLIP) block has been discussed widely in spine surgery. The aim of our study is to evaluate analgesic efficacy and safety of TLIP block in spine surgery.

Method: We performed a quantitative systematic review. Randomized controlled trials that compared TLIP block to non-block care or wound infiltration for patients undergoing spine surgery and took the pain or morphine consumption as a primary or secondary outcome were included. The primary outcome was cumulative opioid consumption during 0-24-hour. Secondary outcomes included postoperative pain intensity, rescue analgesia requirement, and adverse events.

Result: 9 randomized controlled trials with 539 patients were included for analysis. Compared with non-block care, TLIP block was effective to decrease the opioid consumption (WMD -16.00; 95%CI -19.19, -12.81; p<0.001; I2 = 71.6%) for the first 24 hours after the surgery. TLIP block significantly reduced postoperative pain intensity at rest or movement at various time points compared with non-block care, and reduced rescue analgesia requirement ((RR 0.47; 95%CI 0.30, 0.74; p = 0.001; I2 = 0.0%) and postoperative nausea and vomiting (RR 0.58; 95%CI 0.39, 0.86; p = 0.006; I2 = 25.1%). Besides, TLIP block is superior to wound infiltration in terms of opioid consumption (WMD -17.23, 95%CI -21.62, -12.86; p<0.001; I2 = 63.8%), and the postoperative pain intensity at rest was comparable between TLIP block and wound infiltration.

Conclusion: TLIP block improved analgesic efficacy in spine surgery compared with non-block care. Furthermore, current literature supported the TLIP block was superior to wound infiltration in terms of opioid consumption.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA flow diagram.
Fig 1. PRISMA flow diagram.
Fig 2. Risk of bias graph.
Fig 2. Risk of bias graph.
Fig 3. Risk of bias summary.
Fig 3. Risk of bias summary.
Fig 4. Forest plot for the comparison…
Fig 4. Forest plot for the comparison of morphine equivalents (mg) in the first 24 h after surgery.
Fig 5. Forest plot of pain intensity…
Fig 5. Forest plot of pain intensity for the TLIP block versus non-block care studies in the first 24 h after surgery.
(A) Pain intensity at rest for the TLIP block versus non-block care studies in the first 24 h after surgery. (B) Pain intensity at movement for the TLIP block versus non-block care studies in the first 24 h after surgery.
Fig 6. Forest plot of pain intensity…
Fig 6. Forest plot of pain intensity at rest for the TLIP block versus wound infiltration studies in the first 24 h after surgery.
Fig 7. Forest plot of the incidence…
Fig 7. Forest plot of the incidence of rescue analgesia requirement.
Fig 8. Forest plot of the incidence…
Fig 8. Forest plot of the incidence of PONV.

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