Comparison of Ultrasound-Guided Classic And Lateral Approach Thoracolumbar Interfascial Plane Block
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional

Summary: 
      US-guided peripheral nerve blocks have been used increasingly due to the advantages of
      ultrasound in anesthesia practice. TLIP block is one of these nerve blocks performed under US
      guidance. In this technique, local anesthetic solution is injected between the multifidus and
      longissimus muscles nearly at the level of the 3rd lumbar vertebra and targets the dorsal
      rami of the thoracolumbar nerves. However, the visualisation of this technique may be
      difficult under ultrasound (US) guidance. Therefore, Ahiskalioglu et al. defined modified
      lateral technique of TLIP block as a new approach. The aim of this study is to compare
      US-guided classic and modified (lateral) techniques of TLIP block for postoperative analgesia
      management after lumbar laminectomy surgery .
    

Detailed description: 
      Spine surgery in thoracolumbar region is one of the most common surgeries performed for the
      treatment of leg and back pain 1. Pain management is especially important for these patients
      since chronic pain often occurs after surgery. Severe pain may occur at postoperative period
      in patients following lumbar disc herniation (LDH) operation. Postoperative effective pain
      treatment provides early mobilization and shorter hospital stay, thus complications due to
      hospitalization such as infection and thromboembolism may be reduced 1,2.

      Regional anesthesia techniques may be preferred for postoperative analgesia
      management.Thoracolumbar interfascial plane (TLIP) block is a novel ultrasound guided
      regional analgesia technique.

      Several techniques such as intravenous-intramuscular injections, and patient-controlled
      analgesia devices are usually performed for postoperative pain management. However, these
      methods may be ineffective in the pain treatment due to they are generally performed after
      pain has occurred. The analgesic agent may not reach a treatment concentration in the blood
      due to administrating doses intermittently 2.Opioids are one of the most preferred drugs
      among the analgesic agents. Parenteral opioids are generally performed for patients after
      surgery. However opioids have undesirable adverse events such as nausea, vomiting, itching,
      sedation and respiratory depression (opioid-related adverse events) 3.

      Various methods may be performed to reduce the use of systemic opioids and for effective pain
      treatment. US-guided peripheral nerve blocks have been used increasingly due to the
      advantages of ultrasound in anesthesia practice. TLIP block is one of these nerve blocks
      performed under US guidance and defined by Hand et al. in 2015 2. In a retrospective study,
      it has been reported that this technique can provide effective analgesia after lumbar
      laminoplasty surgery by Ueshima et al 4. In this technique, local anesthetic solution is
      injected between the multifidus and longissimus muscles nearly at the level of the 3rd lumbar
      vertebra and targets the dorsal rami of the thoracolumbar nerves. However, the visualisation
      of this technique may be difficult under ultrasound (US) guidance. Therefore, Ahiskalioglu et
      al. defined modified lateral technique of TLIP block as a new approach 5. Ahiskalioglu et al.
      have reported that this approach has some advantages. Firstly, sonographic visualisation is
      more easily than the classical technique. Secondly, insertion of the needle from medial to
      lateral direction reduces the risk of possible neuraxial injection 5.

      The aim of this study is to compare US-guided classic and modified (lateral) techniques of
      TLIP block for postoperative analgesia management after lumbar laminectomy surgery . The
      primary aim is to compare perioperative and postoperative opioid consumption and the
      secondary aim is to evaluate postoperative pain scores (VAS), adverse effects related with
      opioids (allergic reaction, nausea, vomiting) and complications due to blocks.
    

Intervention name(s): Classic block (Group C) and modified block (Group M) groups
Intervention type(s): Other
Intervention description(s): Classic block (Group C) and modified block (Group M) will be performed following induction of general anesthesia, with patients in the prone position by using ultrasound device
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Classic block (Group C) and modified block (Group M) will be performed following induction of general anesthesia, with patients in the prone position
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Thoracolumbar Interfascial Plane Block; Pain Management; Lumbar Laminectomy Surgery