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

Abstract

Background and objectives The erector spinae plane block (ESPB) and classical thoracolumbar interfascial plane (TLIP) block can reduce postoperative pain in lumbar surgery. In this study, we compared the efficacy of ESPB and classical TLIP block in providing perioperative analgesia in patients undergoing lumbar posterior decompression and stabilization by comparing postoperative pain, opioid consumption, and IL-6 and IL-10 serum concentrations between ESPB and classical TLIP block. Method This was a prospective, double-blinded, randomized controlled trial in tertiary referral hospitals. Forty patients were randomized into two equal groups, each receiving either ESPB or classical TLIP block. The primary outcome was the difference in IL-6 and IL-10 serum concentrations at baseline and 6 h after lumbar posterior decompression and stabilization. The secondary outcome was total opioid consumption and pain score 24 h post-operatively. Result There were no significant differences between the ESPB and classical TLIP block groups in pain score, IL-6 and IL-10 concentration change, and total opioid consumption post-operatively. There was a significant difference in the time until the first dose of morphine was needed between the ESPB and classical TLIP block groups (300 min vs. 547.5 min; p = 0.002). Conclusion ESPB and classical TLIP block performance during lumbar surgery have comparable pain scores, IL-6 and IL-10 concentration differences pre- and post-operation, and total opioid consumption post-operatively. However, classical TLIP block provides a prolonged duration of analgesia. Trial registration ClinicalTrials.gov NCT04951024.

Efficacy and Safety of Erector Spinae Plane Block versus Thoracolumbar Interfascial Plane Block in Patients Undergoing Spine Surgery

“…A total of 914 studies were identified by the search strategy, and after all duplicates were deleted, 488 articles entered the screening process, and 391 articles were excluded through title and abstract. After reading the full text, 5 studies [28][29][30][31][32] met the inclusion criteria and were included in the quantitative analysis, as shown in Figure 1. All studies were recent and published between 2020 and 2023, comprising outcomes of ESPB versus TLIP block in patients undergoing spine surgery.…”

“…The 5 studies included 4 RCTs 28,29,31,32 from India, Indonesia, China, and Turkey in English and 1 cohort study 30 in Chinese. In all, 457 patients were included, and there were 234 (51.2%) patients in ESPB group and 223 (48.8%) patients in TLIP block group.…”

“…Four RCTs were considered to have a low risk of bias. 28,29,31,32 The Cochrane risk-of-bias tool reported potential for unclear risk of bias in selection bias, performance bias and detection bias in the study by Ciftci et al 32 The study by Wang et al 31 showed unclear risk of bias in allocation concealment, and the study by Li et al 30 was considered as poor quality through Newcastle-Ottawa Scale. The result of assessment of bias risk is shown in Figures 2A, B.…”

“…Postoperative opioid consumption: 3 studies 28,29,32 involving 160 patients investigated postoperative 24-hour opioid consumption, and 3 studies 28,30,31 involving 357 patients reported postoperative 48 hours opioid consumption in ESPB group and TLIP block group. The results of meta-analysis showed that there was a significant difference between the 2 groups (SMD = −1.31, 95% CI: −2.54 to −0.08, P = 0.04, I 2 = 80%), indicating that ESPB can reduce postoperative opioid consumption in patients undergoing spine surgery compared with TLIP block (Fig.…”

“…Four studies, 28,29,31,32 including 362 patients, reported intraoperative opioid consumption in ESPB group and TLIP block group. Meta-analysis revealed that 95% CI of the combined results exceeded the limit of no effect (SMD = −0.08, 95% CI: −0.58 to 0.42, P = 0.75, I 2 = 78%), indicating that there was no statistically significant difference between the 2 groups.…”