Evaluation of thoracolumbar interfascial plane block for postoperative analgesia after herniated lumbar disc surgery: A randomized clinical trial

Abstract

Background: Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3^rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves.

Objective: The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy.

Methodology: This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation.

Results: TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, P < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, P < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation.

Conclusion: TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.

Keywords: Lumbar disc surgery; nerve block; postoperative pain; thoracolumbar.

Figure 1

Identification of landmarks before proceeding for injection

Figure 2

While injection of local anesthesia between the multifidus and longissimus muscles

Figure 3

Spread of contrast medium that was mixed with local anesthesia

Figure 4

Consort E flowchart

Figure 5

Visual Analog Scale score at rest

Figure 6

Visual Analog Scale score during movement