Comparison of the Efficacy of Thoracolumbar Interfascial Plane Block and Erector Spina Plane Block in Lumbar Discectomy
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Observational

Summary: 
      Patients who will undergo herniated disc surgery have serious pain after surgery. In order to
      minimise this pain and to ensure that they recover more quickly and use less morphine-derived
      painkillers, we aim to apply two types of painkiller injections before surgery. For this
      purpose, it is planned to apply painkiller injections on both sides of the level of the
      herniated disc with sedation before the operation. Afterwards, herniated disc surgery will be
      performed under general anaesthesia.
    

Detailed description: 
      Modified thoracolumbar plane block (mTLIP): under ultrasound-guided, the lateral compartment
      of the longissimus muscle and iliocostal muscle muscles are imagined and the block needle is
      placed in the interfascial plane of these two muscles and local anesthesic solution is
      appliced.

        -  20 ml of 0.25% bupivacaine will be used on each side (total of 40 ml of 0.25%
           bupivacaine will be used)

        -  to be administered only approximately 20-30 minutes before the onset of anaesthesia.

        -  only once in the preoperative block room approximately 20-30 minutes before induction of
           anaesthesia

        -  plane block applications will be performed by anaesthesiologists with at least 5 years
           of experience

        -  patients' intraoperative fentanyl consumption, agitation-sedation scores on awakening
           from anaesthesia, tramadol consumption in the postoperative 24 hours, postoperative VAS
           pain scores, and side effects such as postoperative nausea-vomiting will be evaluated.

        -  plane blocks will be applied under ultrasound guidance.

        -  plane block applications will be performed by anaesthesiologists with at least 5 years
           of experience

        -  Postoperative evaluations of patients will be performed face to face. Patients will be
           routinely administered 1 g paracetamol intravenously at 8 hour intervals in the
           postoperative period. 100 mg tramadol intravenously will be administered if their pain
           is above VAS 4 despite this.

        -  This study was followed up in the neurosurgery unit of SBU Gazi Yasargil Training and
           Research Hospital.

        -  Patients were sedated with 1 mg midazolam and 50 mcg fentanyl intravenously in the
           preoperative preparation room in the operating room and 20 ml of 0.25% bupivacaine was
           administered bilaterally on each side under ultrasound guidance. After the block
           application, the patient was taken to the operating room and standard general
           anaesthesia was applied.

      Patients will be monitored for pain and side effects at the neurosurgery unit , 1st hour, 2nd
      hour, 4th hour, 8th hour and 24th hour in the postoperative period.

      - Both plan blocks are applied for analgesia in the postoperative period and aim to reduce
      opioid consumption in the postoperative period.

      Erector spinae plane block (ESP): After determining the vertebral spinal process and
      trapezius, rhomboid major and erector spinae muscles with ultrasound guidance, the block
      needle is advanced in the cranio-caudal direction with an in plane approach and local
      anaesthetic solution is applied to the plane between the erector spinae muscle and the
      transverse process when the needle rests on the transverse process.

        -  20 ml of 0.25% bupivacaine will be used on each side (total of 40 ml of 0.25%
           bupivacaine will be used)

        -  to be administered only approximately 20-30 minutes before the onset of anaesthesia.

        -  only once in the preoperative block room approximately 20-30 minutes before induction of
           anaesthesia

        -  plane block applications will be performed by anaesthesiologists with at least 5 years
           of experience

        -  patients' intraoperative fentanyl consumption, agitation-sedation scores on awakening
           from anaesthesia, tramadol consumption in the postoperative 24 hours, postoperative VAS
           pain scores, and side effects such as postoperative nausea-vomiting will be evaluated.

        -  plane blocks will be applied under ultrasound guidance.

        -  plane block applications will be performed by anaesthesiologists with at least 5 years
           of experience

        -  Postoperative evaluations of patients will be performed face to face.

      Statistical methods / analysis: G-Power version 3.1.9.4 (Universität Kiel, Germany) program
      was used to calculate the sample size. The two-tailed alpha error was taken as 0.05, power as
      0.80 and effect size as 0.8, and based on a previous study the allocation ratio was accepted
      as N2/N1:1. The minimum number of patients to be included in the study was calculated as 72.

      SPSS 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for other statistical analyses.
      Statistical data were expressed as mean and standard deviation, while categorical data were
      expressed as frequency and percentage. Comparison of categorical data in the groups was done
      with Chi-square, the results were given as %n. Shapiro-Wilk tests were used to determine if
      the numerical data fit the normal distribution. While the data fitting the normal
      distribution were evaluated with the Student's t-test. Mann- Whitney U tests were used to
      compare the data differ from the normal distribution. p <0.05 was considered statistically
      significant.
    

Intervention name(s): Modified thoracolumbar plane block (mTLIP); Erector spinae plane block (ESP)
Intervention type(s): Procedure; Procedure
Intervention description(s): Modified thoracolumbar plane block (mTLIP): under ultrasound-guided, the lateral compartment of the longissimus muscle and iliocostal muscle muscles are imagined and the block needle is placed in the interfascial plane of these two muscles and local anesthesic solution is appliced.
20 ml of 0.25% bupivacaine will be used on each side (total of 40 ml of 0.25% bupivacaine will be used)
to be administered only approximately 20-30 minutes before the onset of anaesthesia.; Erector spinae plane block (ESP): After determining the vertebral spinal process and trapezius, rhomboid major and erector spinae muscles with ultrasound guidance, the block needle is advanced in the cranio-caudal direction with an in plane approach and local anaesthetic solution is applied to the plane between the erector spinae muscle and the transverse process when the needle rests on the transverse process.
20 ml of 0.25% bupivacaine will be used on each side (total of 40 ml of 0.25% bupivacaine will be used)
to be administered only approximately 20-30 minutes before the onset of anaesthesia
Other intervention name(s): Plane block; Plane block
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients to be operated for 1 or 2 level lumbar disc herniation.