Comparing the Effect of Classical and Modified Thoracolumbar Interfascial Plane Block on Postoperative Pain and IL-6 Level in Posterior Lumbar Decompression and Stabilization Surgery

Abstract

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.

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

“…However, there was no difference in Qnor values and total morphine consumption. 96 A study comparing the applicability and analgesic efficacy of TLIPB and mTLIPB in lumbar disc surgery has shown that the applicability of mTLIPB is faster, analgesic efficacy, opioid consumption, and rescue analgesic consumption are similar. 97 In a study evaluating the analgesic efficacy of epidural anesthesia applied during closure in lumbar discectomy surgery and mTLIPB applied before surgery, while there was no difference in opioid consumption in the first 4 hours after surgery, there was a significant decrease in favor of mTLIPB between the 8th and 24th hours in terms of opioid consumption.…”

Monitoring of Analgesia Level During General Anesthesia: Traditional Review

“…64 Tantri ve ark., posterior lomber dekompresyon ve stabilizasyon cerrahisi geçirecek olgularda qNOX kullanımının postoperatif morfin tüketimine etkisi olmadığını saptamışlardır. 65 Bileşik Değişkenlik İndeksi (Composite Variability Index) 2012 yılında BIS'ı desteklemek için bir nosisepsiyon monitörü olarak sunulmuştur. Bileşik Değişkenlik İndeksi [Composite Variability Index (CVI)], frontal elektroensefalografik elektrotlarla ölçülen BIS ve elektromiyografik gücün (EMG) birleşik değişkenliğinin bir indeksi olarak geliştirilmiş ve CVI'daki artışlar intraoperatif somatik tepkilerle ilişkilendirilmiştir.…”

Nyeri Pasca Operasi Dekompresi dan Stabilisasi Vertebra: Sampai Dimana Kita Saat Ini?

“…Pilot studi yang telah dilakukan juga menemukan bahwa baik TLIP klasik maupun modifikasi dapat memperbaiki nyeri intraoperatif. 11 Pada edisi kali ini, Lengkong dkk 12 melakukan studi dengan menggunakan analgesia berupa gabapentin terhadap nyeri pascaoperasi dekompresi dan stabilisasi posterior vertebra. Hasil penelitian ini dapat menjadi pertimbangan bagi para ahli anestesi dalam memutuskan pemilihan dalam manajemen nyeri pasca operasi dekompresi dan stabilisasi vertebra.…”