A prospective and randomized trial comparing modified and classical techniques of ultrasound-guided thoracolumbar interfascial plane block

Objectives: A thoracolumbar interfascial plane (TLIP) block is a novel ultrasound (US)-guided technique that provides effective analgesia after lumbar spinal surgery. Two approaches for a TLIP block have been defined: a classical (cTLIP) technique anda modified (mTLIP) technique. A literature review revealed no published comparison of the 2 techniques. This study examinedthe practicality and analgesic efficacy of US-guided mTLIP and cTLIP blocks following lumbar disc surgery.Methods: Sixty patients aged 18–65 years with an American Society of Anesthesiologists classification of I or II who werescheduled for lumbar disc surgery under general anesthesia were included. US-guided mTLIP (n=30) and cTLIP (n=30) blockswere performed. The performance time of the block procedures, the success of a one-time block, postoperative pain scores,opioid consumption, adverse effects, and block-related complications were recorded and analyzed.Results: The performance time was significantly less in the mTLIP group (p

Ultrason eşliğinde yapılan torakolomber interfasiyal plan bloğunun klasik ve modifiye tekniklerini karşılaştıran prospektif ve randomize çalışma

Amaç: Torakolomber interfasiyal plan (TLIP) bloğu, lumbar spinal cerrahi sonrası etkili analjezi sağlayan, ultrason (US) eşliğinde yapılan yeni bir rejyonal anestezi tekniğidir. Bu bloğun iki farklı tekniği tanımlanmıştır: klasik (cTLIP) ve modifiye (mTLIP) teknik. Literatürde henüz bu iki tekniği karşılaştıran bir çalışma bulunmamaktadır. Çalışmamızda lomber disk cerrahisi sonrası US eşliğinde mTLIP ve cTLIP bloklarının işlem uygulama kolaylığını ve analjezik etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: Amerikan Anestezistler Derneği (American Society of Anesthesiologist/ASA) anestezi risk sınıflamasına göre sınıf I-II, 18-65 yaş arası ve genel anestezi altında lomber disk cerrahisi planlanan 60 hasta çalışmaya dahil edildi. Hastalara US eşliğinde mTLIP (n=30) ve cTLIP (n=30) blok uygulandı. Blok uygulama süresi, tek seferde blok başarısı, opioid tüketimi, postoperatif ağrı skorları, yan etkiler ve bloğa bağlı komplikasyonlar kaydedildi. Bulgular: Blok uygulama süresi mTLIP grubunda anlamlı derecede düşüktü (p

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1. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 2009;64(2):344–5.

2. Efthymiou CA, O’Regan DJ. Postdischarge complications: what exactly happens when the patient goes home? Interact Cardiovasc Thorac Surg 2011;12(2):130–4.

3. Hand WR, Taylor JM, Harvey NR, Epperson TI, Gunselman RJ, Bolin ED, et al. Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Can J Anaesth 2015;62(11):1196–200.

4. Ahiskalioglu A, Yayik AM, Alici HA. Ultrasound-guided lateral thoracolumbar interfascial plane (TLIP) block: Description of new modified technique. J Clin Anesth 2017;40:62.

5. Ahiskalioglu A, Alici HA, Selvitopi K, Yayik AM. Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach. Can J Anaesth 2017;64(7):775–6.

6. Li C, Jia J, Qin Z, Tang Z. The use of ultrasound-guided modified thoracolumbar interfascial plane (TLIP) block for multilevel lumbar spinal surgery. J Clin Anesth 2018;46:49–51.

7. Ueshima H, Ozawa T, Toyone T, Otake H. Efficacy of the Thoracolumbar Interfascial Plane Block for Lumbar Laminoplasty: A Retrospective Study. Asian Spine J 2017;11(5):722–5.

8. Ueshima H, Otake H. Clinical efficacy of modified thoracolumbar interfascial plane block. J Clin Anesth 2016;30:74–5.

9. Ahiskalioglu A, Yayik AM, Doymus O, Selvitopi K, Ahiskalioglu EO, Calikoglu C, et al. Efficacy of ultrasound-guided modified thoracolumbar interfascial plane block for postoperative analgesia after spinal surgery: a randomizedcontrolled trial. Can J Anaesth 2018;65(5):603–4.

10. Ahiskalioglu A, Yayik AM, Celik EC, Aydin ME, Uzun G. Ultrasound guided modified Thoracolumbar Interfascial Plane block for low back pain management. J Clin Anesth 2019;54:138–9.

11. Ueshima H, Otake H. Ultrasound-guided thoracolumbar interfascial plane block: Complications in 175 consecutive cases. J Clin Anesth 2019;58:5–6.

12. Ueshima H, Oku K, Otake H. Ultrasound-guided thoracolumbar interfascial plane block: a cadaveric study of the spread of injectate. J Clin Anesth 2016;34:259–60.

13. Ueshima H, Hara E, Otake H. Thoracolumbar interfascial plane block provides effective perioperative pain relief for patients undergoing lumbar spinal surgery; a prospective, randomized and double blinded trial. J Clin Anesth 2019;58:12–7.

14. Ueshima H, Otake H. Ultrasound-guided “lateral” thoracolumbar interfascial plane (TLIP) block: A cadaveric study of the spread of injectate. J Clin Anesth 2017;40:54.

15. Ueshima H, Otake H. Clinical experiences with s combination of thoracolumbar interfascial plane (TLIP) with modified TLIP blocks. J Clin Anesth 2019;54:2.

16. Hamilton DL. Does Thoracolumbar Interfascial Plane Block Provide More Focused Analgesia Than Erector Spinae Plane Block in Lumbar Spine Surgery? J Neurosurg Anesthesiol. doi: 10.1097/ANA.0000000000000643. [Epub ahead of print]

17. Xu JL, Doherty T, Patel R, Galeno J, Dotzauer B. Analgesic efficacy of ultrasound-guided modified thoracolumbar interfascial plane block performed with the use of neurophysiology monitoring for postoperative lumbar surgery. J Clin Anesth 2019;52:21–3.

18. Xu JL, Tseng V. Proposal to standardize the nomenclature for paraspinal interfascial plane blocks. Reg Anesth Pain Med. doi: 10.1136/rapm-2019-100696. [Epub ahead of print]

19. Ueshima H. Lumbar thoracolumbar interfascial plane block provides effective analgesia for spondylosis. J Clin Anesth. doi: 10.1016/j.jclinane.2019.03.005. [Epub ahead of print]