Background: Ultrasound (US)-guided classical and modified thoracolumbar interfascial plane (TLIP) blocks are often used to provide adequate analgesia after lumbar spinal surgery. Postoperative pro-inflammatory interleukin 6 (IL-6) blood concentrations after lumbar spine surgery are related to postoperative pain and inflammation. Objectives: The purpose of this prospective randomized parallel controlled study was to assess postoperative pain and serum levels of pro-inflammatory IL-6 after posterior lumbar decompression and stabilization surgery with a classical and modified technique of TLIP block. Methods: This prospective randomized, single-blinded controlled pilot study was conducted on eight patients who will undergo posterior lumbar decompression and stabilization surgery. After obtaining the ethical approval and an informed consent, all subjects were randomly allocated into the classic TLIP group and the modified TLIP group. Following general anesthesia induction, 20 mL bupivacaine 0.25% was injected on each side in interfascialis plane between m. longissimus and m. iliocostalis in modified TLIP group and between m. multifidus and m. longissimus in classical TLIP group. Intraoperative hemodynamic (blood pressure and heart rate) and noxious stimulation response level (qNOX), postoperative IL-6 level, 24-hour morphine consumption, and numerical rating score were recorded and analyzed. Results: The median of IL-6 level was found to be lower in the modified TLIP group 12 hours postoperatively compared to classic TLIP (29.91 (8.56 – 87.61) vs. 46.87 (2.87 – 92.35)). The mean Numerical Rating Scale (NRS) in the modified TLIP block was comparable with the classic TLIP group, although it was lower than the classic TLIP group (2.75 ± 1.5 vs. 3.75 ± 1.7 at 6 hours and 3.5 ± 1.3 vs. 4 ± 1.6 12 hours postoperatively). However, there was no difference in intraoperative hemodynamic, Qnox value, and total postoperative morphine consumption between the two groups. Conclusions: Our study showed that modified TLIP block resulted in lower IL-6 level and NRS 12 hours postoperatively compared to classical TLIP block. However, there were no differences in total postoperative morphine consumption between the two groups.

Introduction As one of the top ranks in the pain-producing procedure, spinal surgery requires adequate perioperative pain management to improve outcomes. Likewise, perioperative pain management in cirrhotic hepatic patients with thrombocytopenia is quite challenging. Modified TLIP block can be an option for perioperative pain management in the lumbar decompression surgery for a cirrhotic hepatic patient with thrombocytopenia. Case Presentation A man, 67 years old, who suffered from cirrhosis hepatic with thrombocytopenia underwent endoscopic spinal decompression with laminotomy and flavectomy of L4-L5. After induction of general anesthesia with midazolam 1,5 mg, fentanyl 150 mcg, propofol 100 mg, and rocuronium 1mg/kg, patient was intubated. The lungs were ventilated with a pressure control mode with tidal volume 8 ml/kg BW, respiratory rate 12/min, and PEEP 5 cmH2O with FiO2 50%. and 1% sevoflurane. Modified TLIP block was performed at L3 level. Twenty ml of bupivacaine 0,5% was administered between the longissimus and iliocostalis muscles on both sides. Results Intraoperative, modified TLIP block provide adequate analgesia with stable hemodynamics. The visual Analog Scale (VAS) of pain was 1-2 in 24h postoperative. No additional opioid was required within 24 hours postoperatively. There were no neurological complications or bleeding due to modified TLIP block found in this patient. Conclusion Modified TLIP block can be an effective and safe analgesic technique for hepatic cirrhosis patients with thrombocytopenia. However, further research is needed to determine the safety limits of modified TLIP block in patients with coagulation disorder or anticoagulant use.