Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries – A prospective double-blinded randomised controlled trial

Abstract

Background and Aims: Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic. Methods: Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically. Results: The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001. Conclusion: TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic.

Thoracolumbar Interfascial Plane (TLIP) block verses other paraspinal fascial plane blocks and local infiltration for enhanced pain control after spine surgery: a systematic review

“…When TLIP blocks were compared against wound infiltration of local anesthesia, two studies, Ince et al [ 19 ] and Bicak et al [ 27 ], found wound infiltration was as effective as a TLIP block for postoperative pain relief. On the other hand, Ekinci et al [ 26 ] and Pavithran et al [ 15 ] found TLIP blocks to be superior.…”

Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial

“…In our study, we found that classical TLIP block provides a longer duration of analgesia. Nonetheless, the duration of analgesia of classic TLIP block and ESPB remains inconclusive [ 27 , 38 , 39 ]. Both ESPB and classical TLIP block could provide analgesia 12–24 h after lumbar surgery.…”

The Shining Star of the Last Decade in Regional Anesthesia Part-II: Interfascial Plane Blocks for Cardiac, Abdominal, and Spine Surgery

“…A study evaluating the efficacy of TLIPB in posterior spine fusion surgery revealed that the time of first rescue analgesia was statistically delayed in patients treated with TLIPB compared to the control group and the infiltration group. 94 A meta-analysis study evaluating the postoperative analgesic efficacy of TLIPB in lumbar spine surgery indicated that TLIPB significantly reduced pain at rest and movement in the postoperative period and reduced PCA consumption. 95 In posterior lumbar decompression and stabilization surgery patients comparing TLIPB and mTLIPB with postoperative pain and IL-6 level, it was observed that IL-6 level and numeric rating scale averages were lower in the mTLIPB group.…”