Thoracolumbar interfascial plane block better than LA infiltration

Due to the substantial dissection and muscle retraction conducted during spine procedures, patients experience acute postoperative discomfort. Postoperative analgesia is a key component of these patients' perioperative treatment. Several cocktail formulations including different adjuvants have been investigated for use in wound infiltration during spine procedures. In posterior lumbar spine fusion procedures, the thoracolumbar interfascial plane (TLIP) block produced greater analgesia than wound infiltration. A recently published study compared the analgesic effectiveness of TLIP block to that of wound infiltration with local anesthetic, in terms of the time required to seek the first dosage of rescue analgesic.

Seventy-one patients scheduled for posterior lumbar spine fusion under general anesthesia were included in this randomised controlled experiment with double-blinding. Patients were randomly assigned to receive either a TLIP block (TLIP group) or wound infiltration prior to surgery (LI group). The key outcome measure was the first request for rescue analgesia. Secondary outcomes were the total amount of tramadol used, as well as pain and comfort levels recorded at different time periods throughout the first 48 hours after surgery. After the second interim analysis, the study was ended since the analgesic advantage of TLIP was clinically and statistically obvious. The median (interquartile range) length of the first request for rescue analgesia was 1440 minutes (1290 minutes to 2280 minutes) in the TLIP group and 340 minutes (180 minutes to 360 minutes) in the infiltration group; P .001. In the infiltration group, the mean tramadol consumption was substantially greater than in the TLIP group (P .001).

The experiment reveals that the TLIP block provides greater postoperative analgesia compared to wound infiltration with a local anesthetic combination. Patients who underwent TLIP block had a longer pain-free period and required more time before requesting the first dose of rescue analgesia. In addition, the overall dosage of rescue analgesics ingested was considerably lower in the TLIP group. Since TLIP blockade does not interfere with motor function, it may facilitate early ambulation and recovery. In order to further investigate the analgesic effectiveness and safety of the TLIP block, it should be compared to other paraspinal blocks.

Reference –

Pavithran, Priyanka,; Sudarshan, Pramod K.1; Eliyas, Salin2; Sekhar, Biju; Kaniachallil, Kishore Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries – A prospective double-blinded randomised controlled trial, Indian Journal of Anaesthesia: June 2022 - Volume 66 - Issue 6 - p 436-441

doi: 10.4103/ija.ija_1054_21