Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation

Alver, Selcuk; Ciftci, Bahadir; Celik, Erkan Cem; Sargolzaeimoghaddam, Maral; Cetinkal, Ahmet; Erdogan, Cem; Ahiskalioglu, Ali

doi:10.1007/s00586-023-07812-3

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…In the initial classical form of the TLIP block, a local anesthetic is administered into the plane situated between the multifidus and longissimus muscles, selectively targeting the dorsal ramus and medial branch [9,11]. Subsequently, this technique underwent modification by Ahıskalıoglu et al modified TLIP block, the local anesthetic is administered into the anatomical plane situated between the longissimus and iliocostalis muscles, with the intention of selectively affecting the corresponding nerves.…”

Section: Discussionmentioning

confidence: 99%

“…In the posterior quadratus lumborum block (QLB), local anesthetic is administered in a plane immediately lateral to that utilized in the erector spinae plane block (ESPB) [5,13,25]. This technique effectively blocks the lateral and anterior cutaneous branches of the ilioinguinal, iliohypogastric, and subcostal nerves, which innervate the lower abdominal region as well as the paraspinal region by extending posteriorly and blocking branches of the dorsal ramus [9,[26][27][28]. The QLB can be performed through three distinct approaches: anterior, posterior, and lateral.…”

Section: Discussionmentioning

confidence: 99%

“…Interfascial plane blocks, including the thoracolumbar interfascial plane (TLIP) block, erector spinae plane (ESP) block, and quadratus lumborum block (QLB), play a significant role in contemporary medical practice for enhancing post-spinal surgery pain management. These blocks are also employed with the objective of mitigating the adverse effects associated with opioid use, such as nausea, vomiting, allergic reactions, sedation, and respiratory depression [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Canikli Adıgüzel,

Akyurt,

Bahadır Altun

et al. 2023

JCM

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Introduction: The management of postoperative pain following lumbar disc herniation (LDH) surgery is crucial for the quality of recovery. The effectiveness of multimodal analgesia plans increases when interfascial plane blocks are included. This study sought to compare the analgesic efficacy of preoperative ultrasound-guided TLIP (thoracolumbar interfascial plane) blocks and posterior QLBs (quadratus lumborum blocks) in patients undergoing LDH surgery. Methods: Patients undergoing elective LDH surgery under general anesthesia were randomized into two groups: thoracolumbar interfascial plane block (Group T) and posterior quadratus lumborum block (Group Q). Block applications were performed 30 min before anesthesia induction. In the postoperative period, analgesia control was provided with a patient-controlled analgesia device. The patients’ 24 h cumulative opioid consumption was examined. Pain scores were evaluated in the 0th, 3rd, 6th, 9th, 12th, and 24th hours. Results: The mean 24 h cumulative morphine consumption for patients was statistically insignificant when Groups T and Q were compared (9.14 ± 7.03 mg vs. 8.66 ± 6.58 mg, p = 0.788). Pain scores at rest and during movement as well as morphine consumption were similar between groups in the 0th, 3rd, 6th, 9th, 12th, and 24th hours (p > 0.05). Conclusions: The study determined that the utilization of TLIP blocks and posterior QLBs prior to anesthesia induction yielded comparable outcomes in terms of reducing postoperative analgesic consumption and enhancing the efficacy of multimodal analgesia in individuals undergoing single-distance lumbosacral spine surgery under general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Canikli Adıgüzel,

Akyurt,

Bahadır Altun

et al. 2023

JCM

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

Patel,

McNicholas,

Paschell

et al. 2024

BMC Anesthesiol

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Spinal surgeries are accompanied by excessive pain due to extensive dissection and muscle retraction during the procedure. Thoracolumbar interfascial plane (TLIP) blocks for spinal surgeries are a recent addition to regional anesthesia to improve postoperative pain management. When performing a classical TLIP (cTLIP) block, anesthetics are injected between the muscle (m.) multifidus and m. longissimus. During a modified TLIP (mTLIP) block, anesthetics are injected between the m. longissimus and m. iliocostalis instead. Our systematic review provides a comprehensive evaluation of the effectiveness of TLIP blocks in improving postoperative outcomes in spinal surgery through an analysis of randomized controlled trials (RCTs).We conducted a systematic review based on the PRISMA guidelines using PubMed and Scopus databases. Inclusion criteria required studies to be RCTs in English that used TLIP blocks during spinal surgery and report both outcome measures. Outcome data includes postoperative opioid consumption and pain.A total of 17 RCTs were included. The use of a TLIP block significantly decreases postoperative opioid use and pain compared to using general anesthesia (GA) plus 0.9% saline with no increase in complications. There were mixed outcomes when compared against wound infiltration with local anesthesia. When compared with erector spinae plane blocks (ESPB), TLIP blocks often decreased analgesic use, however, this did not always translate to decreased pain. The cTLIP and mTLP block methods had comparable postoperative outcomes but the mTLIP block had a significantly higher percentage of one-time block success.The accumulation of the current literature demonstrates that TLIP blocks are superior to non-block procedures in terms of analgesia requirements and reported pain throughout the hospitalization in patients who underwent spinal surgery. The various levels of success seen with wound infiltration and ESPB could be due to the nature of the different spinal procedures. For example, studies that saw superiority with TLIP blocks included fusion surgeries which is a more invasive procedure resulting in increased postoperative pain compared to discectomies.The results of our systematic review include moderate-quality evidence that show TLIP blocks provide effective pain control after spinal surgery. Although, the application of mTLIP blocks is more successful, more studies are needed to confirm that superiority of mTLIP over cTLIP blocks. Additionally, further high-quality research is needed to verify the potential benefit of TLIP blocks as a common practice for spinal surgeries.

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Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation

Cited by 2 publications

References 24 publications

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial

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

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