An mTLIP Block for Analgesia Management After Lumbar Spinal Surgery.
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional

Summary: 
      Pain management is an important issue following lumbar spinal surgery. Wound infiltration is
      a technique that a local anesthetic solution is infiltrated into the tissues around the
      surgical area. Modified thoracolumbar interfacial plane (mTLIP) block was described by
      Ahiskalioglu et al. In this study, the investigators aimed to compare the analgesic efficacy
      of the US-guided mTLIP block and wound infiltration following lumbar disc surgery.
    

Detailed description: 
      Spinal surgery in the lumbar region is one of the most common surgeries performed for leg and
      back pain. Postlumbar surgery pain can be severe and may progress to chronic pain during the
      postoperative period. Therefore, pain management is important after lumbar spinal surgery.
      Effective postoperative pain management enables early mobilization and shorter durations of
      hospital stays and may also reduce hospitalization-related complications, such as infections
      and thromboembolism.

      There are a variety of techniques for postoperative pain management. These include
      intravenous-intramuscular injections, patient-controlled analgesia devices, local anesthetic
      infiltration, and regional anesthesia. Among these techniques, intramuscular and intravenous
      (IV) injections may be ineffective in pain management, as they are generally administered
      after the pain has commenced. In addition, intermittent treatment with analgesic agents may
      not result in a therapeutic level in the blood.

      The most common analgesic agents used postoperatively are opioids. However, parenteral
      opioids may result in undesirable adverse events, such as nausea, vomiting, itching,
      sedation, and respiratory depression. Various methods are available to reduce the use of
      systemic opioids in postoperative pain management, one of which is local anesthetic
      infiltration (wound infiltration) into the operation site. Several studies reported that
      wound infiltration can reduce opioid consumption following surgery. Various regional
      anesthesia techniques can also be used to manage postoperative pain. Such techniques have a
      high success rate, especially if they are applied with ultrasound (US) guidance, as US
      improves visualization, thereby reducing potential complications. Previous research reported
      that US-guided modified thoracolumbar interfacial plane (mTLIP) block after lumbar spinal
      surgery via a lateral approach provided effective analgesia. No studies seem to have compared
      the analgesic effectiveness of wound infiltration versus TLIP block. In this study, the
      investigators compared the analgesic efficacy of the US-guided mTLIP block and wound
      infiltration following lumbar disc surgery. The primary aim was to compare postoperative
      opioid consumption. The secondary aim was to evaluate postoperative pain scores and adverse
      effects of opioids, such as allergic reactions, nausea, and vomiting.
    

Intervention name(s): TLIP block group (group T); Wound infiltration group (group W)
Intervention type(s): Other; Other
Intervention description(s): In group T, the block was performed bilaterally under aseptic conditions using the US device with a high-frequency 12-MHz linear US probe. The probe was covered with a sterile sheath and placed vertically at the L3 vertebrae level. After visualizing the hyperechoic shadow of the spinous process and interspinous muscles as an anatomical guide point, the probe was moved forward in a lateral direction to visualize the longissimus and iliocostal muscles. Using the in-plane technique, a 22-G, 50-mm block needle was inserted between the muscles in a medial-to-lateral direction in the interfascial plane. Once the needle tip was placed within the interfacial plane and after careful aspiration to rule out intravascular needle placement, 2 ml of saline was injected to confirm the accuracy of the injection site. A dose of 0.25% bupivacaine (20 ml) was then injected in each side (total 40 ml).; In group W, a dose of 0.5% bupivacaine (20 ml) was injected for wound infiltration into the surgery site.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients were aged 18-65 years, American Society of Anesthesiologists classification I-II, and scheduled for lumbar disc surgery under general anesthesia. The patients were randomly divided into two groups using a randomizing computer program: a TLIP block group (group T) and a wound infiltration group (group W), with 30 patients in each group).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar spinal surgery; Postoperative pain management; Modified thoracolumbar interfacial plane block