tlip block and esp block for perioperative analgesia in patients with lumbar spine fusion surgery

Conditions: Analgesia; Spine Fusion

Summary: background: pain relief for lumbar spine surgery is being updated to help improve the quality of post-operative recovery, especially ultrasound-guided pain relief anesthesia methods, including two anesthesia methods. thoracolumbar interfascial plane block (tlip block) and erector spinae plane block (esp block) are increasingly commonly applied. objective: compare the pain relief effectiveness of tlip block with esp block for lumbar spine surgery. methods: randomized prospective intervention study conducted at hanoi medical university hospital from october 2021 to october 2022 including 100 lumbar spine surgery patients randomly divided into three groups: group control, tlip group and esp group. outcomes regarding perioperative pain score (anim, vas), the effectiveness of 2 ultrasound-guided methods, the complications and the side effects were recorded.

* all research patients were divided into 3 groups by random drawing: control group, tlip group and esp group. * tlip group: patients were anesthetized before surgery using tlip lumbar block (l3) under ultrasound with 20ml of ropivacaine 0.25% anesthetic on each side. after that, the patient was given endotracheal anesthesia for surgery. * esp group: patients were anesthetized before surgery with lumbar (l3) esp block method under ultrasound with 20ml of ropivacaine 0.25% anesthetic on each side. after that, the patient was given endotracheal anesthesia for surgery. * control group: patients received regular endotracheal anesthesia, then the incision was anesthetized with 15ml of 1% lidocaine mixed with 1/200,000 adrenaline on each side before surgery. * anesthesia and monitoring process: all patients in all 3 groups were anesthetized using general anesthesia: * install monitoring to monitor pulse parameters, blood pressure, spo2, etco2. * install an analgesia nociception index (ani) meter and monitor the ani index continuously during surgery. monitor ani monitor v2 during surgery, maintain anim within the range of 50-70. * induction of anesthesia: fentanyl 2mcg/kg slow intravenous injection, wait 3 minutes then inject propofol 2-3mg/kg, rocuronium 0.6mg/kg (when eyelid reflex is lost). proceed with endotracheal intubation and artificial ventilation at a frequency of 12 times/minute, vt = 6-8ml/kg, fio2 50%, i:e = 1:2, peep = 5cmh2o, etco2 = 35-45mmhg, sevoflurane install until mac reaches 0.8-1. * maintain anesthesia with sevofluran, maintain 1 mac. * using fentanyl during surgery: when anim index is less than 50: 50mcg fentanyl bolus, repeat after 5 minutes until anim greater than 50. record the amount of fentanyl used during surgery. record the anim index at the time of the study: when skin incision (t0) and every 10 minutes until the end of surgery. * release of anesthesia: patients are extubated when they meet the criteria: awake, following orders, breathing rate 12-20 times/minute, spo2 \> 95% with fio2 ≤ 40%, vt \> 5ml/kg, etco2 \< 45 mmhg , good cough and swallow reflex and tof ≥ 90%. after extubation, monitor the patient, record pulse index, blood pressure and vas score and transfer the patient to the hospital room if it reaches 10/10 points according to aldrete. * pain relief: both groups received paracetamol 1g and ketorolac 30mg at the end of skin closure and every 8 hours thereafter. when the patient has postoperative pain (vas score ≥ 4), they are titrated with intravenous morphine 1mg/time every 10 minutes until reaching a vas score \< 4. at the same time, an intravenous morphine pain relief machine is installed. patient controlled analgesia (pca) with bolus setting 1ml = 1mg, lockout time 10 minutes, maximum dose 20mg/4 hours, no background infusion dose.

Eligibility criteria:
inclusion criteria: * american society of anesthesiologists (asa) physical status i-iii. * patients had lumbar spinal fusion surgery. exclusion criteria: * the patient does not agree to participate in the study. * patients with severe chronic diseases: liver failure, kidney failure, heart failure, arrhythmia, neuromuscular disease. * patients are using drugs that affect the autonomic nervous system such as beta blockers, parasympathomimetic drugs. * history of mental disorders, difficulty in communication. * patients with acute lumbar spine injury or a history of lumbar spine surgery, injections, abscesses, and lumbar infections.

Keywords: perioperation thoracolumbar interfasial plane erector spine plane ultrasound-guided analgesia patient-controlled analgesia