Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

Abstract

Objective: Ultrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery.

Methods: A prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I-II), aged 21-74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively.

Results: Opioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups.

Conclusion: Our study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

Keywords: Lumbar spine surgery; Pain; Postoperative analgesia; Thoracolumbar interfascial plane block.

Conflict of interest statement

The authors declare there are no competing interests.

©2019 Chen et al.

Figures

Figure 1. CONSORT Flow Diagram.

Figure 2. Image of the spread of lateral TLIP block.

(A) Illustration landmarks and needle approach to the TLIP block. (B) Sonographic image for the TLIP block. The LA injected between the erector spinae muscle and the tip of the transverse processes, anesthetizes the dorsal ramus of the spinal nerves and their branches that innervate the paraspinal muscles and bony vertebrae. L = longissmus muscle; I = illocostalis muscle; M = multifidus muscle; TP = transverse process;SP = spinous process; L3 = lumbar vertebrae 3; lateral TLIP = lateral thoracolumbar Interfascial plane. (Source credit part A: Ke Chen).

Figure 3. Comparison of VAS andBCS at post-operation 1 h, 12 h, 24 h, 36 h, 48 h.

A, VAS at movement time; B, VAS at rest time; C, Bruggrmann Comfort Scale.