Different Volumes of Local Anesthetics in Thoracolumbar Interfascial Plane Block
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Ultrasound-guided thoracolumbar interfascial plane block (TLIP)was first described in 2015 by
      Hand et al which also target the dorsal rami of the thoracolumbar nerves as they pass through
      the paraspinal musculature(between the multifidus muscle (MF) and the longissimus muscle
      (LG)). The block was performed bilaterally at the level of L3 and they reported a
      reproducible area of anesthesia to pinprick in a mean (SD) area covering 137.4 (71.0) cm2 of
      the lower back (including the midline) after 20 minutes of the block. This procedure has
      subsequently been modified by Ueshima H et al in 2016 by targeting the injection in the plane
      between the longissimus and iliocostalis muscles (mTLIP) which helps avoiding the spread of
      local anesthetics to the ventral ramus and neuraxial space, thus, the modified TLIP block is
      considered to be a more refined version of the original TLIP block and safer and easier to
      perform.

      There are limited number of studies investigating the analgesic efficacy of mTLIP block
      however, no previous study has demonstrated the ideal local anesthetic volume for this block
      in lumber spine surgery. Moreover, this technique is considered new regional anesthetic
      techniques and so both of them should be involved in further studies, on the other hand the
      comparison between both of them at the same study wasn't discussed before, and so we will
      proceed at this study.
    

Detailed description: 
      The aim of this study is to compare the post-operative analgesic efficacy of two different
      volumes of local anesthetics in bilateral modified thoracolumbar interfascial plane block in
      lumbar spine surgeries.

      Prospective randomized double blinded study The study will be conducted in Kasr Alainy
      hospital orthopedic surgical theater. Adult patients undergoing lumbar spine surgeries
      involving 1 up to 3 adjacent lumbar vertebrae (eg. laminectomy, discectomy …). at Kasr Alainy
      hospital.
    

Intervention name(s): Thoracolumbar interfascial plane block (TLIP)Technique; Anesthetic Management; Bupivacaine Injection 10ml; Bupivacaine Injection 20ml
Intervention type(s): Procedure; Procedure; Drug; Drug
Intervention description(s): A curvilinear array ultrasound probe (Siemens ACUSON X300 Ultrasound System) will be placed at the targeted lumbar level.The corresponding spinous process and interspinal muscles will be identified, and the probe will be slided laterally to identify the longissimus muscle and iliocostalis muscle. Under ultrasound guidance, A 38-mm 22-gauge (22-G, 50-mm 'Stimuplex; BBraun, Melsung, Germany) regional block needle will be advanced in plane to the ultrasound beam in a medial to lateral orientation through the belly of longissimus muscle toward the iliocostalis muscle. Hydro-dissection with 2-3 ml of isotonic saline solution will confirm the correct needle tip position and, after negative aspiration, 0.25 % bupivacaine will be injected slowly whilst carefully monitoring the spread of local anesthetic into the fascial plane between the longissimus and iliocostalis muscles. The same procedure will be repeated on the contralateral side.; Induction:
Induction of general anesthesia will be performed using a regimen of IV 2 μg/kg fentanyl and propofol IV 2 mg /kg. Tracheal intubation will be facilitated using 0.5 mg/kg IV of atracurium.
Maintenance:
Anesthesia will be maintained with inhaled isoflurane 0.8% in oxygen enriched air (FiO2=0.5). Maintenance doses of 0.1 m\kg atracurium will be provided every 30 minutes. Then the patient will be placed in prone position.; patients will receive single shot of bilateral modified thoracolumbar interfascial plane block at the mid-level of the operative intervention with 20 ml 0.25%bupivacaine (10 ml on each side).; patients will receive single shot of bilateral modified thoracolumbar interfascial plane block at the mid-level of the operative intervention with 40 ml 0.25%bupivacaine (20 ml on each side).
Intervention MeSH terms: Bupivacaine; Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment