TLIP Block and ESP Block For Perioperative Analgesia In Patients With Lumbar Spine Fusion Surgery
Condition: Analgesia; Spine Fusion
MeSH terms: Agnosia
Study type: Interventional

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.
    

Detailed description: 
      -  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.
    

Intervention name(s): TLIP Block For Perioperative Analgesia In Patients With Lumbar Spine Fusion Surgery; ESP Block For Perioperative Analgesia In Patients With Lumbar Spine Fusion Surgery; Lidocaine injection
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Patients were placed in a prone position;
ultrasound-guided TLIP block: (1) The transducer was positioned in a transverse midline position at the level of the L3 vertebra. After the identification of the spinous process and interspinous muscles. (2) The probe was moved laterally to identify the multifidus (MF) and longissimus (LG) muscles. (3) the TLIP block was performed under real-time ultrasound guidance using an insulated 100-mm 22G echogenic needle which was inserted in-plane lateral to the medial direction. (4) After negative aspiration, 20-mL 0.25% ropivacaine was injected in each side bilaterally in the interface between the MF and LG muscles.
patients received general anesthesia; Patients were placed in a prone position;
ultrasound-guided ESP block: (1) The 12th rib was identified in the parasagittal plane, and with probe shifted caudad and medial, the L3 transverse process (TP) was identified. (2) Insulated 100-mm 22G echogenic needle was inserted from cranial to caudal direction. (3) The needle tip was identified between the L2 and L3, and 20 mL of 0.25% ropivacaine was injected in each side bilaterally in ESP.
patients received general anesthesia; patients received general anesthesia
the expected incision was anesthetized with 15ml of 1% lidocaine mixed with 1/200,000 adrenaline on each side before surgery.
Intervention MeSH terms: Lidocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: TLIP block group, ESP block group and control group
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: perioperation; Thoracolumbar interfasial plane; erector spine plane; ultrasound-guided analgesia; patient-controlled analgesia