Ultrasound-guided thoracolumbar interfascial plane block: a cadaveric study of the spread of injectate

Ueshima, Hironobu; Oku, Kazunori; Okumura, Hiroshi

doi:10.1016/j.jclinane.2016.04.060

Cited by 13 publications

(10 citation statements)

References 2 publications

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“…Reducing both perioperative opioid requirements and postoperative pain is one of the goals of enhanced recovery after surgery (Ince et al 2019). TLIP block, which blocks the dorsa rami of thoracolubar nerves, has recently been reported as a useful method for preoperative anesthesia in some cases, such as multilevel lumbar spinal surgery (Ueshima et al 2016a;Ueshima et al 2016b). In our study, the pain score in the TLIP group at rest and movement were lower compared with the control group.…”

Section: Discussionsupporting

confidence: 43%

Peer Review #1 of "Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial (v0.1)"

2019

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Ultrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery. Methods. A prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I-II), aged 21-74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n=30) and control group (Group C, n=30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patientcontrolled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively. Results. Opioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P<0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P<0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P<0.05). There was no significant

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Section: Discussionsupporting

confidence: 43%

Peer Review #1 of "Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial (v0.1)"

2019

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“…Reducing both perioperative opioid requirements and postoperative pain is one of the goals of enhanced recovery after surgery (Ince et al, 2019). TLIP block, which blocks the dorsa rami of thoracolubar nerves, has recently been reported as a useful method for preoperative anesthesia in some cases, such as multilevel lumbar spinal surgery (Ueshima, Oku & Otake, 2016a; Ueshima, Sakai & Otake, 2016b). In our study, the pain score in the TLIP group at rest and movement were lower compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

Chen

Wang

Meng

et al. 2019

PeerJ

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ObjectiveUltrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery.MethodsA prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively.ResultsOpioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups.ConclusionOur study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

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“…1 This block involves injecting local anesthetics between the multifidus and longissimus muscles at the third lumbar vertebral level to block the dorsal rami of thoracolumbar nerves. 2 Hand et al made the injection between the multifidus and longissimus muscles by positioning the block needle at a 30°angle from the skin and advanced it from a lateral to medial direction ( Figure).…”

Section: To the Editormentioning

confidence: 99%

Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach

Ahıskalıoğlu

Alici

Selvitopi

et al. 2017

Can J Anesth/J Can Anesth

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To the Editor,A recent study published by Hand et al. described an ultrasonography-guided thoracolumbar interfascial plane (TLIP) block. 1 This block involves injecting local anesthetics between the multifidus and longissimus muscles at the third lumbar vertebral level to block the dorsal rami of thoracolumbar nerves. 2 Hand et al. made the injection between the multifidus and longissimus muscles by positioning the block needle at a 30°angle from the skin and advanced it from a lateral to medial direction ( Figure).Herein, we describe our TLIP modification where we inject the anesthetics between the longissimus and iliocostalis muscles after having advanced the needles at a 15°angle in a medial to lateral direction. Our modified method has several advantages.1. Advancing the needle from a medial to lateral direction eliminates the risk of possible inadvertent neuraxial injection.2. Injecting between the iliocostalis and longissimus muscles results in a dermatomal area of analgesia similar to that obtained with an injection made between the multifidus and longissimus muscles. We have demonstrated this area of analgesia using radiopaque dye injections (with specific patient consent) where the distribution of the local anesthetics spread two levels caudal and cranial to the injection site. Twenty minutes after injection, we could show a corresponding dermatomal area (using a pinprick test) of reduced sensation. 3. Sonographic imaging more easily discerns the distinction between the longissimus and iliocostalis muscles than between the multifidus and longissimus muscles, thereby potentially increasing the success rate of the block.These modifications to the TLIP block will require further study to investigate their potential advantages more fully. Such investigations, including magnetic resonance imaging and cadaveric studies combined with ultrasonography, should be beneficial for evaluating the block's potential anatomic spread. When compared with some other nerve blocks, interfascial plane blocks are highly dependent on sufficient volumes of local anesthetics to spread between the muscle layers and fascial planes. The TLIP block might be useful for 2 and 3 vertebral level spinal surgical procedures as well as minimally invasive spinal surgery.

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Ultrasound-guided thoracolumbar interfascial plane block: a cadaveric study of the spread of injectate

Cited by 13 publications

References 2 publications

Peer Review #1 of "Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial (v0.1)"

Peer Review #1 of "Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial (v0.1)"

Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach

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